Provider Demographics
NPI:1962096461
Name:JOHNSON, MICHAELA QUIST (MA, ATC)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:QUIST
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 N PACIFIC ST UNIT 22
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-1945
Mailing Address - Country:US
Mailing Address - Phone:760-846-1404
Mailing Address - Fax:
Practice Address - Street 1:838 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2034
Practice Address - Country:US
Practice Address - Phone:858-755-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer