Provider Demographics
NPI:1881375673
Name:WHEELER, ERICA SHYNISE (LMT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:SHYNISE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2467 FAYE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-2098
Mailing Address - Country:US
Mailing Address - Phone:904-518-4555
Mailing Address - Fax:904-518-4565
Practice Address - Street 1:2467 FAYE RD STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-2098
Practice Address - Country:US
Practice Address - Phone:904-518-4555
Practice Address - Fax:904-518-4565
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA72631225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty