Provider Demographics
NPI:1386074540
Name:JOHNSON, BRANDON SCOTT (LAT, ATC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:SCOTT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:MISENHEIMER
Mailing Address - State:NC
Mailing Address - Zip Code:28109-0960
Mailing Address - Country:US
Mailing Address - Phone:704-463-3211
Mailing Address - Fax:704-463-5051
Practice Address - Street 1:48380 US 52 N
Practice Address - Street 2:
Practice Address - City:MISENHEIMER
Practice Address - State:NC
Practice Address - Zip Code:28109
Practice Address - Country:US
Practice Address - Phone:704-582-2138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer