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NPI Code Detail

MEDICARE: MR. SCOTT JOSEPH JOHNSON

MEDICARE:  MR. SCOTT JOSEPH JOHNSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer0126000012VA

General Provider Information

NPI Number : 1972870293
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SCOTT JOSEPH JOHNSON
Provider Business Mailing Address
First Line : ATHLETIC DEPARTMENT
Second Line : OLD DOMINION UNIVERSITY
City : NORFOLK
State : VA
Zip : 23529-0001
Country : US
Telephone Number : 757-683-3383
Fax Number : 757-683-5445
Provider Business Practice Location Address
First Line : ATHLETIC DEPARTMENT
Second Line : OLD DOMINION UNIVERSITY
City : NORFOLK
State : VA
Zip : 23529-0001
Country : US
Telephone Number : 757-683-3383
Fax Number : 757-683-5445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2011
Last Update Date : 12/01/2011

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Directions to “ MR. SCOTT JOSEPH JOHNSON ” Practice Location

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