Individual
BENJAMIN EDWARD MICHAEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2751 2ND AVE N STOP 9013, HYSLOP SPORTS CENTER ROOM 144, GRAND FORKS, ND 58202-9013
(701) 777-6572
Mailing address
2751 2ND AVE N STOP 9013, HYSLOP SPORTS CENTER ROOM 144, GRAND FORKS, ND 58202-9013
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
517-13
ND
Other
Enumeration date
03/10/2015
Last updated
03/10/2015
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