Individual
GARY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, PT
Contact information
Practice address
1440 MONROE ST, MADISON, WI 53711-2051
(608) 225-0302
Mailing address
1440 MONROE ST, MADISON, WI 53711-2051
(608) 225-0302
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1089-039
WI
Other
Enumeration date
02/13/2015
Last updated
02/13/2015
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