Provider Demographics
NPI:1376782938
Name:WHEELER, JENNIFER ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2188 BETTY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH KORTRIGHT
Mailing Address - State:NY
Mailing Address - Zip Code:13842-2116
Mailing Address - Country:US
Mailing Address - Phone:607-437-4092
Mailing Address - Fax:
Practice Address - Street 1:3310 FALL HILL AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3000
Practice Address - Country:US
Practice Address - Phone:540-373-7133
Practice Address - Fax:540-373-0068
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602220225200000X
IN06003352A225200000X
NY006303-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant