Provider Demographics
NPI:1336343631
Name:WHEELER, RICHARD DUKE (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DUKE
Last Name:WHEELER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:R
Other - Middle Name:CLIFFORD
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2360 EDGEHILL RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2320
Mailing Address - Country:US
Mailing Address - Phone:419-350-9640
Mailing Address - Fax:
Practice Address - Street 1:3949 SUNFOREST CT
Practice Address - Street 2:SUITE 101
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4473
Practice Address - Country:US
Practice Address - Phone:419-474-3399
Practice Address - Fax:419-474-5165
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT1921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2208864Medicaid
OH000000217664OtherANTHEM
OH366706Medicare ID - Type Unspecified