Provider Demographics
NPI:1477671410
Name:WHEELER, DARIN MICHAEL (ATC)
Entity Type:Individual
Prefix:MR
First Name:DARIN
Middle Name:MICHAEL
Last Name:WHEELER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702-7205
Mailing Address - Country:US
Mailing Address - Phone:570-327-1315
Mailing Address - Fax:
Practice Address - Street 1:120 PENN ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:PA
Practice Address - Zip Code:17752-1144
Practice Address - Country:US
Practice Address - Phone:570-547-1608
Practice Address - Fax:570-547-6755
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0035102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer