Individual
JENNIFER LEE JOHANNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
101 REGENT CT, STATE COLLEGE, PA 16801-7965
(800) 505-2101
(814) 231-1319
Mailing address
PO BOX 157, 185 BEACH STREET, BLANCHARD, PA 16826-0157
(570) 962-3440
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT004010
PA
Other
Enumeration date
11/01/2006
Last updated
07/08/2007
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