Provider Demographics
NPI:1164552600
Name:WHEELER, GREGORY L (PT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:WHEELER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 771596
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-1596
Mailing Address - Country:US
Mailing Address - Phone:352-751-3781
Mailing Address - Fax:352-751-0169
Practice Address - Street 1:13690 N US HIGHWAY 441
Practice Address - Street 2:SUITE 400
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6810
Practice Address - Country:US
Practice Address - Phone:352-751-3781
Practice Address - Fax:352-751-0169
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist