Provider Demographics
NPI:1114954781
Name:WHEELER, LYNDSAY GAIL (MS, ATC, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:LYNDSAY
Middle Name:GAIL
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 FEATHER RUN TRL
Mailing Address - Street 2:A7
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4966
Mailing Address - Country:US
Mailing Address - Phone:803-467-7912
Mailing Address - Fax:803-786-3868
Practice Address - Street 1:412 N JEFFRIES ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-3126
Practice Address - Country:US
Practice Address - Phone:573-581-7126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer