Provider Demographics
NPI:1205679503
Name:WHEELER, LADEE ANN Z
Entity type:Individual
Prefix:
First Name:LADEE ANN
Middle Name:Z
Last Name:WHEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LADEE ANN
Other - Middle Name:Z
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2501 W ORANGE GROVE RD UNIT 68
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3417
Mailing Address - Country:US
Mailing Address - Phone:520-999-1006
Mailing Address - Fax:
Practice Address - Street 1:2501 W ORANGE GROVE RD UNIT 68
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3417
Practice Address - Country:US
Practice Address - Phone:520-999-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-29611225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty