Healthcare Provider Details

I. General information

NPI: 1487130381
Provider Name (Legal Business Name): JOHNA KAY REGISTER MIHALIK PHD, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 STALLINGS EVANS SPORTS MEDICINE CENTER CB# 8700
CHAPEL HILL NC
27599-0001
US

IV. Provider business mailing address

CB 8700 125 FETZER HALL
CHAPEL HILL NC
27599-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-962-0409
  • Fax:
Mailing address:
  • Phone: 919-962-2702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0979
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: