Individual
SHAWN MICHAEL WISEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1 ATHLETIC CENTER DR, HAMPDEN SYDNEY D, VA 23943-2394
(434) 223-6843
Mailing address
102 HORSLEY DR, HAMPTON, VA 23666-2272
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126002208
VA
Other
Enumeration date
01/10/2018
Last updated
12/09/2019
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