Individual
MATTHEW MARK JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MS, ATC, CSCS
Contact information
Practice address
160 E 6TH PL, FITCH PARK, MESA, AZ 85201-5068
(480) 668-4565
(480) 668-4546
Mailing address
442 N KENSINGTON AVE, LA GRANGE PARK, IL 60526-1872
(617) 680-1863
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0338
AZ
2255A2300X
Athletic Trainer
AT-214
ID
2255A2300X
Athletic Trainer
—
IL
Other
Enumeration date
02/08/2006
Last updated
07/08/2007
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