Provider Demographics
NPI:1659410710
Name:WILKINSON, RYAN DAVID (EDD, LAT, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:DAVID
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:EDD, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5630
Mailing Address - Country:US
Mailing Address - Phone:262-853-7181
Mailing Address - Fax:
Practice Address - Street 1:2065 HALF DAY RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-1241
Practice Address - Country:US
Practice Address - Phone:847-317-7136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI527-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer