Provider Demographics
NPI:1114473154
Name:WHEELER, MICHAEL (DPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:WHEELER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 COMMED BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8300
Mailing Address - Country:US
Mailing Address - Phone:386-774-4404
Mailing Address - Fax:386-774-4496
Practice Address - Street 1:830 COMMED BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8300
Practice Address - Country:US
Practice Address - Phone:386-774-4404
Practice Address - Fax:386-774-4496
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT 31985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist