National Provider Identifier
Samara Daeva Joy Johnson, ATC
Samara Daeva Joy Johnson, ATC is listed in the NPPES registry with a primary specialty of Athletic Trainer in Churchville, NY and a listed phone number of (716) 986-3193.
Profile Overview
- NPI
- 1225673551
- Provider Type
- Individual
- Primary Specialty
- Athletic Trainer
- Enumeration Date
- November 11, 2019
- Last Updated
- July 10, 2020
Practice Location
- 15 Royce Dr
- Churchville, NY 14428-8900
Phone: (716) 986-3193
Specialties
- Athletic Trainer (2255A2300X)
- Student in an Organized Health Care Education/Training Program (390200000X)
Endpoints
- sjohn23@brockport.edu
Direct Messaging Address | Direct | Csv | Churchville, NY 14428
Full Record
- NPI
- 1225673551
- Entity Type
- Individual
- Last Name
- Johnson
- First Name
- Samara
- Middle Name
- Daeva Joy
- Credential
- ATC
- Mailing Street Address
- 15 Royce Dr
- Mailing City
- Churchville
- Mailing State
- NY
- Mailing ZIP Code
- 14428-8900
- Mailing Country
- US
- Practice Street Address
- 15 Royce Dr
- Practice City
- Churchville
- Practice State
- NY
- Practice ZIP Code
- 14428-8900
- Practice Country
- US
- Practice Phone
- (716) 986-3193
- Enumeration Date
- November 11, 2019
- Last Updated
- July 10, 2020
- Sex
- Female
- Sole Proprietor
- No
- Certification Date
- July 10, 2020
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Athletic Trainer (2255A2300X), Student in an Organized Health Care Education/Training Program (390200000X)