Provider Demographics
NPI:1497271670
Name:WHEELOCK, KRYSTLE AMANDA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KRYSTLE
Middle Name:AMANDA
Last Name:WHEELOCK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WARREN CIR
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-2762
Mailing Address - Country:US
Mailing Address - Phone:540-631-5184
Mailing Address - Fax:
Practice Address - Street 1:413 MCCLELLAN ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-1420
Practice Address - Country:US
Practice Address - Phone:540-931-9856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist