Provider Demographics
NPI:1366854291
Name:WHEELER, BETTY (PT)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47581 815TH RD
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-5362
Mailing Address - Country:US
Mailing Address - Phone:308-728-4070
Mailing Address - Fax:866-411-4048
Practice Address - Street 1:47581 815TH RD
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-5362
Practice Address - Country:US
Practice Address - Phone:308-728-4070
Practice Address - Fax:866-411-4048
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist