Individual
TEQUILA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3894 COVINGTON RD, SOUTH EUCLID, OH 44121-1949
(216) 647-4787
Mailing address
3894 COVINGTON RD, SOUTH EUCLID, OH 44121-1949
(216) 647-4787
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
SC327232
OH
Other
Enumeration date
04/09/2019
Last updated
04/09/2019
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