Individual
MR. BRENT JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
404 CAYLAND CT, CHESAPEAKE, VA 23322-3624
(757) 482-4013
Mailing address
404 CAYLAND CT, CHESAPEAKE, VA 23322-3624
(757) 482-4013
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PTA 23821
FL
Other
Enumeration date
04/18/2015
Last updated
01/28/2016
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