Individual
SAMUEL WICHAEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, ATC, CES
Contact information
Practice address
4422 KNIGHTS VICTORY WAY, ORLANDO, FL 32816-8019
(407) 823-4303
Mailing address
3326 MISSION BAY BLVD APT 130, ORLANDO, FL 32817-1997
(303) 217-1789
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3692
FL
Other
Enumeration date
07/14/2017
Last updated
07/14/2017
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