Provider Demographics
NPI:1689766503
Name:WHEELER VICKERY, DANIELLE J (PT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:J
Last Name:WHEELER VICKERY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:SUITE 2104 PM AND E DEPT
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-464-2300
Mailing Address - Fax:315-464-2305
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:SUITE 2104 PM AND E DEPT
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-2300
Practice Address - Fax:315-464-2305
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0170111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD3044Medicare ID - Type Unspecified