Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Blake Wickerham, LAT, ATC

Individual provider Athletic Trainer · NPI 1275959876

Blake Wickerham, LAT, ATC is an Athletic Trainer in Raleigh, North Carolina. Practices as a sole proprietor. Licensed in North Carolina.

Licensed in
NC
In the registry since
2014
What do these letters mean?
LAT — Licensed Athletic Trainer
A state-licensed athletic trainer.
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

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Practice location Address checks out

3121 Woods Pl
Raleigh, NC 27607-5231
Phone: (919) 515-2111
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X · Licence 2254 (NC)

Record details

NPI number1275959876
Entity typeIndividual (Type 1)
GenderMale
Credentials LAT , ATC
Sole proprietorYes
NPI enumeratedMarch 7, 2014
Last updated in NPPESMarch 7, 2014

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