Provider Demographics
NPI:1023418258
Name:WHEELER, DANIELLE (DPT)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:DYKSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1039 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57730-1304
Mailing Address - Country:US
Mailing Address - Phone:605-673-9476
Mailing Address - Fax:605-673-4954
Practice Address - Street 1:1039 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730-1304
Practice Address - Country:US
Practice Address - Phone:605-673-9476
Practice Address - Fax:605-673-4954
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist