Individual
GABRIELLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
9155 SW BARNES RD, PORTLAND, OR 97225-6625
(503) 216-1234
Mailing address
9155 SW BARNES RD STE 440, PORTLAND, OR 97225-6631
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT-10165263
OR
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
12/06/2019
Last updated
10/29/2024
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