Individual
DETEVIA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
12701 SADDLE CLUB CIR APT 202, TAMPA, FL 33635-9689
(850) 691-7238
Mailing address
12701 SADDLE CLUB CIR APT 202, TAMPA, FL 33635-9689
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL4169
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J525173926260
DRIVER'S LICENSE
FL
Enumeration date
08/31/2017
Last updated
08/31/2017
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