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WILSON MATTHEW MCKNIGHT ATC
Athletic Trainer >> Specialist/Technologist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1063949691
Individual Registrant: WILSON MATTHEW MCKNIGHT ATC
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
1164 MAIN STREET VILONIA, AR 72173-7217 US
Tel: 501-472-4442 Fax: 501-472-4442
Tel: 501-472-4442 Fax: 501-472-4442
Contact information for business:
14 KIMBERLY DRIVE VILONIA, AR 72173 US
Tel: 501-472-4442 Fax: --
Tel: 501-472-4442 Fax: --
Registration Information:
NPI: 1063949691
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist Athletic Trainer | AR | 677 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
