Provider Demographics
NPI:1982652830
Name:WHEELER, CHRISTIAN DALE (MPT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:DALE
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16412 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834
Mailing Address - Country:US
Mailing Address - Phone:804-520-7779
Mailing Address - Fax:866-463-3047
Practice Address - Street 1:16412 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834
Practice Address - Country:US
Practice Address - Phone:804-520-7779
Practice Address - Fax:866-463-3047
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305 202615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist