Individual
SHANICE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
WELLNESS AND APPLIED MEDICINE RM 201 5TH ST, TERRE HAUTE, IN 47809-0001
(812) 237-9613
Mailing address
3012 S 8TH ST, TERRE HAUTE, IN 47802-3934
(330) 412-0975
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001923A
IN
Other
Enumeration date
04/02/2012
Last updated
04/02/2012
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