Individual
MISS KRYSTAL GENEVA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., ATC
Contact information
Practice address
5838 HARBOUR VIEW BLVD, STE 130, SUFFOLK, VA 23435-2663
(757) 673-5971
Mailing address
3919 BREEZEPORT WAY, APT 203, SUFFOLK, VA 23435-3808
(757) 484-7477
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
06/24/2010
Last updated
06/24/2010
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