Individual
MISS LORI KARINA JOHANNESSEN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
101 PAGE ST, NEW BEDFORD, MA 02740-3464
(508) 971-5155
Mailing address
1040 SHELBURNE ST, NEW BEDFORD, MA 02745-3036
(508) 998-0594
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1466
MA
Other
Enumeration date
08/09/2005
Last updated
07/08/2007
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