Individual
MATTHEW JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18220 SAN LUCAS CT, BROOKFIELD, WI 53045-3870
(262) 993-1383
Mailing address
18220 SAN LUCAS CT, BROOKFIELD, WI 53045-3870
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
WI
Other
Enumeration date
05/11/2015
Last updated
05/11/2015
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