Provider Demographics
NPI:1639129398
Name:WHEELER, KIMBERLY ANN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1440
Mailing Address - Country:US
Mailing Address - Phone:856-346-4088
Mailing Address - Fax:
Practice Address - Street 1:1103 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:OAKLYN
Practice Address - State:NJ
Practice Address - Zip Code:08107
Practice Address - Country:US
Practice Address - Phone:856-858-9601
Practice Address - Fax:856-858-1363
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01028500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist