Provider Demographics
NPI:1972870293
Name:JOHNSON, SCOTT JOSEPH
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JOSEPH
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ATHLETIC DEPARTMENT
Mailing Address - Street 2:OLD DOMINION UNIVERSITY
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23529-0001
Mailing Address - Country:US
Mailing Address - Phone:757-683-3383
Mailing Address - Fax:757-683-5445
Practice Address - Street 1:ATHLETIC DEPARTMENT
Practice Address - Street 2:OLD DOMINION UNIVERSITY
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23529-0001
Practice Address - Country:US
Practice Address - Phone:757-683-3383
Practice Address - Fax:757-683-5445
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260000122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer