Individual
LYLLIE CHRISTINE MC BRIDE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
13837 CIRCA CROSSING DR, LITHIA, FL 33547-4382
(203) 733-6035
Mailing address
3384 SUNCOAST PLAINS DR, ODESSA, FL 33556-2935
(203) 733-6035
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
6676
FL
2255A2300X
Athletic Trainer
2000051414
FL
Other
Enumeration date
06/21/2022
Last updated
04/09/2024
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