Provider Demographics
NPI:1376588921
Name:WHEELER, HEATHER LYNE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LYNE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24637 FRY RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:16403-2107
Mailing Address - Country:US
Mailing Address - Phone:814-763-4917
Mailing Address - Fax:814-333-5668
Practice Address - Street 1:1034 GROVE ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2945
Practice Address - Country:US
Practice Address - Phone:814-333-5214
Practice Address - Fax:814-333-5668
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer