Individual
MISS LYDIA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
9200 UNIVERSITY BLVD, NORTH CHARLESTON, SC 29406-9121
(843) 863-7412
(843) 863-7392
Mailing address
412 VINICIO DR, GOOSE CREEK, SC 29445-3666
(828) 545-2801
(843) 863-7392
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT1062
KY
Other
Enumeration date
06/29/2016
Last updated
06/29/2016
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