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General NPI Number Information
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NPI Number | 1245584770
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Entity Type | Individual
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Provider Name | MICHELLE M JOHNSON MS, ATC
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Gender | Female
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 1 HAWK DR 103 ELTING GYMNASIUM
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City | NEW PALTZ
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State | NY
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Zip | 12561-2447
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Country | US
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Telephone | 845-257-3928
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Fax |
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Provider Business Mailing Address
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Address Line | 24 TURTLE ROCK CT
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City | NEW PALTZ
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State | NY
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Zip | 12561-1127
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001403-1
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License Number State | NY
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