Provider Demographics
NPI:1164469326
Name:WHEELER, DONNA L (MSPT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10137 NW 19TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-2507
Mailing Address - Country:US
Mailing Address - Phone:352-875-4143
Mailing Address - Fax:
Practice Address - Street 1:7750 SW 60TH AVE STE E
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6472
Practice Address - Country:US
Practice Address - Phone:352-433-1918
Practice Address - Fax:352-433-0950
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL320118406OtherTAX ID
FL889719100Medicaid
FLY909COtherBCBS