Provider Demographics
NPI:1144513219
Name:WHEELER, AMY RENAE (PT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:RENAE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-2276
Mailing Address - Country:US
Mailing Address - Phone:219-979-0396
Mailing Address - Fax:219-427-0571
Practice Address - Street 1:900 N SHELBY ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-2276
Practice Address - Country:US
Practice Address - Phone:219-979-0396
Practice Address - Fax:219-427-0571
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005024A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist