Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1226699 | TX |
N | 2251N0400X | Physical Therapist - Neurology | 1226699 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1226699 | TX |
NPI | 1427492941 |
---|---|
Provider Name | Dr. Kenneth Wheeler |
First Address | Fort Worth, TX 76104-3946 |
Second Address | Fort Worth, TX 76104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2013 |
Last Update Date | 11/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
394270801 | (05) | TX |