Provider Demographics
NPI:1932977808
Name:WHEAT, KARLIE MICHELE
Entity Type:Individual
Prefix:
First Name:KARLIE
Middle Name:MICHELE
Last Name:WHEAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 PARDUE AVE
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-1641
Mailing Address - Country:US
Mailing Address - Phone:985-750-5669
Mailing Address - Fax:
Practice Address - Street 1:821 PARDUE AVE
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-1641
Practice Address - Country:US
Practice Address - Phone:985-750-5669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist