Individual
KENNETH TODD JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11470 88TH AVE, SEMINOLE, FL 33772-3602
(727) 623-0676
Mailing address
11470 88TH AVE, SEMINOLE, FL 33772-3602
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
J525518662420
FL
Other
Enumeration date
01/21/2019
Last updated
01/21/2019
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