Individual
JACOB JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
33610 WASHINGTON ST NE, CAMBRIDGE, MN 55008-9153
(763) 221-7190
Mailing address
33610 WASHINGTON ST NE, CAMBRIDGE, MN 55008-9153
(763) 221-7190
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/05/2017
Last updated
10/05/2017
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