Individual
ABBY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT
Contact information
Practice address
16550 W 78TH STREET, SUITE B, EDEN PRAIRIE, MN 55346
(952) 873-7400
Mailing address
16650 WEST 78TH STREET, SUITE B, EDEN PRAIRIE, MN 55346
(952) 873-7400
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
1509-39
WI
2255A2300X
Athletic Trainer
Primary
2741
MN
Other
Enumeration date
08/05/2014
Last updated
05/25/2016
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