Provider Demographics
NPI:1356304737
Name:WHEELWRIGHT, DALE C (RPT)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:C
Last Name:WHEELWRIGHT
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 N 600 W
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-5533
Mailing Address - Country:US
Mailing Address - Phone:208-782-2267
Mailing Address - Fax:208-684-9812
Practice Address - Street 1:7 N 600 W
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-5533
Practice Address - Country:US
Practice Address - Phone:208-782-2267
Practice Address - Fax:208-684-9812
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT-1406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010140771OtherNDPT REGENCE BS OF ID
IDT6947OtherNDPT BLUE CROSS OF ID
ID5586533OtherNDPT CCN
ID806464000Medicaid
ID1654501Medicare ID - Type UnspecifiedNEW DAY PHYSICAL THERAPY
ID000010140771OtherNDPT REGENCE BS OF ID