National Provider Identifier
Lydia Alice Johnson
Lydia Alice Johnson is listed in the NPPES registry with a primary specialty of Athletic Trainer in Brockport, NY and a listed phone number of (585) 395-5374.
Profile Overview
- NPI
- 1235859778
- Provider Type
- Individual
- Primary Specialty
- Athletic Trainer
- Enumeration Date
- September 02, 2022
- Last Updated
- September 02, 2022
Practice Location
- 350 New Campus Dr
- Brockport, NY 14420-2914
Phone: (585) 395-5374
Mailing Address
- 636 Park Hill RD
- Erin, NY 14838-9755
Specialties
- Athletic Trainer (2255A2300X)
Full Record
- NPI
- 1235859778
- Entity Type
- Individual
- Last Name
- Johnson
- First Name
- Lydia
- Middle Name
- Alice
- Mailing Street Address
- 636 Park Hill RD
- Mailing City
- Erin
- Mailing State
- NY
- Mailing ZIP Code
- 14838-9755
- Mailing Country
- US
- Practice Street Address
- 350 New Campus Dr
- Practice City
- Brockport
- Practice State
- NY
- Practice ZIP Code
- 14420-2914
- Practice Country
- US
- Practice Phone
- (585) 395-5374
- Enumeration Date
- September 02, 2022
- Last Updated
- September 02, 2022
- Sex
- Female
- Sole Proprietor
- No
- Certification Date
- September 02, 2022
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Athletic Trainer (2255A2300X)