Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT010989 | GA |
NPI | 1003252701 |
---|---|
Provider Name | Stevi Denise Wheeler |
First Address | Ooltewah, TN 37363-6511 |
Second Address | Conyers, GA 30013-2076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2013 |
Last Update Date | 21/05/2013 |