Provider Demographics
NPI:1851716237
Name:WHEELER, PAUL ALAN III (MS, ATC, CES)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ALAN
Last Name:WHEELER
Suffix:III
Gender:M
Credentials:MS, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 E MONTE CRISTO AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4275
Mailing Address - Country:US
Mailing Address - Phone:602-290-2795
Mailing Address - Fax:480-484-6895
Practice Address - Street 1:7501 E VIRGINIA AVE
Practice Address - Street 2:M125
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-1522
Practice Address - Country:US
Practice Address - Phone:480-484-6858
Practice Address - Fax:480-484-6895
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer