Individual
JOHNSON MYRTIAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 E CITY AVE STE 210, BALA CYNWYD, PA 19004-1734
(856) 827-7630
Mailing address
301 E CITY AVE STE 210, BALA CYNWYD, PA 19004-1734
(856) 827-7643
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/13/2022
Last updated
12/13/2022
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