Provider Demographics
NPI:1629262803
Name:WHEELWRIGHT, JONATHAN (PT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:WHEELWRIGHT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5782 ADAMS AVE PKWY
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6947
Mailing Address - Country:US
Mailing Address - Phone:801-917-8080
Mailing Address - Fax:801-917-8001
Practice Address - Street 1:5782 ADAMS AVE PKWY
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6947
Practice Address - Country:US
Practice Address - Phone:801-917-8080
Practice Address - Fax:801-917-8001
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8241055-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist