Provider Demographics
NPI:1396356424
Name:PAVLICH-WHEELER, DENALI LEEONA (DPT)
Entity Type:Individual
Prefix:
First Name:DENALI
Middle Name:LEEONA
Last Name:PAVLICH-WHEELER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N TACOMA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3131
Mailing Address - Country:US
Mailing Address - Phone:253-274-1884
Mailing Address - Fax:
Practice Address - Street 1:1 N TACOMA AVE STE 103
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3131
Practice Address - Country:US
Practice Address - Phone:253-274-1884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic