Provider Demographics
NPI:1629117924
Name:WHEATLEY, TRACEY L (RDMS,RVT,RDCS)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:L
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:RDMS,RVT,RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 W GORE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1124
Mailing Address - Country:US
Mailing Address - Phone:407-880-9179
Mailing Address - Fax:407-814-2459
Practice Address - Street 1:70 W GORE ST STE 202
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1124
Practice Address - Country:US
Practice Address - Phone:407-880-9179
Practice Address - Fax:407-814-2459
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL938612471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography