Individual
MR. KEITH VINCENT JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, NRAEMT
Contact information
Practice address
13 FAHNESTOCK RD, MALVERN, PA 19355-2104
(610) 633-1478
Mailing address
13 FAHNESTOCK RD, MALVERN, PA 19355-2104
(610) 633-1478
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT001618A
PA
Other
Enumeration date
02/15/2007
Last updated
12/16/2015
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