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General NPI Number Information
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NPI Number | 1467823914
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Entity Type | Individual
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Provider Name | CAITLYN JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 600 22ND ST NW
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City | WASHINGTON
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State | DC
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Zip | 20052-0055
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Country | US
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Telephone | 202-424-6743
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 DORR AVE APT 228
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City | FAIRFAX
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State | VA
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Zip | 22031-4936
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Country | US
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Telephone | 703-909-4020
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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 | 0126002007
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License Number State | VA
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