Provider Demographics
NPI:1952604928
Name:WILKENFELD, DAVID A (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:WILKENFELD
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 S MAIN ST
Mailing Address - Street 2:WELLNESS CENTER
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-2738
Mailing Address - Country:US
Mailing Address - Phone:336-631-1584
Mailing Address - Fax:
Practice Address - Street 1:1533 S MAIN ST
Practice Address - Street 2:WELLNESS CENTER
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-2738
Practice Address - Country:US
Practice Address - Phone:336-631-1584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer