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General NPI Number Information
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NPI Number | 1710911169
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Entity Type | Individual
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Provider Name | REBECCA LYNN JOHNSON ATC
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 802 N RIVERSIDE RD SUITE 250
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City | SAINT JOSEPH
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State | MO
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Zip | 64507-9794
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Country | US
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Telephone | 816-271-7676
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 4TH AVE
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City | SAINT JOSEPH
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State | MO
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Zip | 64505-2108
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Country | US
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Telephone | 816-383-3979
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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 | 2004035417
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License Number State | MO
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