Individual
BLAKE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
590 S WAKARA WAY, SALT LAKE CITY, UT 84108-1200
(801) 587-0757
Mailing address
1629 W BLACK GOLD DR, BLUFFDALE, UT 84065-2386
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
6976729-4810
UT
Other
Enumeration date
02/27/2015
Last updated
02/27/2015
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