Individual
PHILLIP CURTIS WILKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
4251 POWHATAN AVE, NORFOLK, VA 23508-2225
(757) 683-4255
Mailing address
413 LAKE HAVASU DR, VIRGINIA BEACH, VA 23454-3976
(757) 381-3280
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126002836
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003741
STATE LICENSURE
OH
01
—
0126002836
STATE LICENSURE
VA
01
—
096.002700
STATE LICENSURE
IL
01
—
120402189
BOC CERTIFICATION
—
01
—
408
STATE LICENSURE
AR
Enumeration date
10/05/2017
Last updated
10/05/2017
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