Provider Demographics
NPI:1013433069
Name:WHEELER, CARMILLA (FITNESS TRAINER)
Entity Type:Individual
Prefix:
First Name:CARMILLA
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:FITNESS TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12515 LANGNER DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744
Mailing Address - Country:US
Mailing Address - Phone:202-253-7539
Mailing Address - Fax:
Practice Address - Street 1:12515 LANGNER DRIVE
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744
Practice Address - Country:US
Practice Address - Phone:240-779-1622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1013433069Medicaid