Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A2451 | MD |
NPI | 1013114057 |
---|---|
Provider Name | Mr. Michael Allan Wheeler |
First Address | North East, MD 21901-1137 |
Second Address | Phoenix, AZ 85021-7967 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 08/07/2007 |