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General NPI Number Information
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NPI Number | 1841280526
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Entity Type | Individual
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Provider Name | LAUREN MARY JOHNSON ATC, LAT, ARRT (MRI)
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Gender | Female
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 5555 W THUNDERBIRD RD
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City | GLENDALE
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State | AZ
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Zip | 85306-4622
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Country | US
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Telephone | 602-865-5594
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Fax |
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Provider Business Mailing Address
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Address Line | 13809 N 49TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85306-4922
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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 | 0415
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License Number State | AZ
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