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Individual

SAMARA DAEVA JOY JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
15 ROYCE DR, CHURCHVILLE, NY 14428-8900
(716) 986-3193
Mailing address
15 ROYCE DR, CHURCHVILLE, NY 14428-8900

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2773
SC
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
11/11/2019
Last updated
07/10/2020
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