Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE012021 | PA |
NPI | 1003386749 |
---|---|
Provider Name | Alexis Kaylynne Wheeler |
First Address | Hollidaysburg, PA 16648-5247 |
Second Address | Hollidaysburg, PA 16648-5247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2018 |
Last Update Date | 26/11/2018 |