Individual
LYDIA ALICE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
350 NEW CAMPUS DR, BROCKPORT, NY 14420-2914
(585) 395-5374
Mailing address
636 PARK HILL RD, ERIN, NY 14838-9755
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
004486
NY
Other
Enumeration date
09/02/2022
Last updated
09/02/2022
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