Individual
JOHN J JOHNSEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
800 ALGOMA BLVD, OSHKOSH, WI 54901-3551
(920) 424-3225
Mailing address
1570 MIDWAY PL, MENASHA, WI 54952-1165
(920) 720-1784
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
4939
WI
Other
Enumeration date
10/19/2005
Last updated
07/08/2007
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