Individual
MR. JEFFREY TODD JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
720 4TH AVE S, 214 HALENBECK HALL, SAINT CLOUD, MN 56301-4442
(320) 308-2503
Mailing address
332 RIVERSIDE DR NE, SAINT CLOUD, MN 56304-0345
(320) 656-1453
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1088
MN
Other
Enumeration date
01/19/2007
Last updated
07/08/2007
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