Individual
SAMUEL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
101 WOMENS BLDG, OREGON STATE UNIVERSITY, CORVALLIS, OR 97331-8577
(541) 737-6801
Mailing address
101 WOMENS BLDG, OREGON STATE UNIVERSITY, CORVALLIS, OR 97331-8577
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
10117134
OR
Other
Enumeration date
07/16/2014
Last updated
07/16/2014
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