Provider Demographics
NPI:1386745636
Name:WHEELER, AMY JEANETTE (ATC LAT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JEANETTE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:ATC LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GYPSUM
Mailing Address - State:CO
Mailing Address - Zip Code:81637-5164
Mailing Address - Country:US
Mailing Address - Phone:970-376-8728
Mailing Address - Fax:
Practice Address - Street 1:641 VALLEY RD
Practice Address - Street 2:
Practice Address - City:GYPSUM
Practice Address - State:CO
Practice Address - Zip Code:81637-5164
Practice Address - Country:US
Practice Address - Phone:970-376-8728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00015622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer