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General NPI Number Information
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NPI Number | 1659410710
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Entity Type | Individual
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Provider Name | RYAN DAVID WILKINSON EDD, LAT, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 2065 HALF DAY RD
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City | DEERFIELD
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State | IL
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Zip | 60015-1241
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Country | US
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Telephone | 847-317-7136
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Fax |
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Provider Business Mailing Address
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Address Line | 967 VISTA DR
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City | GURNEE
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State | IL
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Zip | 60031-5630
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Country | US
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Telephone | 262-853-7181
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 527-039
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License Number State | WI
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