Individual
TERRY LUCAS WILLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, CSCS
Contact information
Practice address
1325 SAN MARCO BLVD, JACKSONVILLE, FL 32207-8568
(904) 858-7045
Mailing address
355 MONUMENT RD, 13-C, JACKSONVILLE, FL 32225-6486
(801) 866-2800
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL 3139
FL
2255A2300X
Athletic Trainer
RT004553
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
ATHLETIC TRAINER
FL
01
—
22
ATHLETIC TRAINER
PA
Enumeration date
09/03/2009
Last updated
08/16/2011
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