Provider Demographics
NPI:1932971686
Name:WHEELER, TY
Entity type:Individual
Prefix:
First Name:TY
Middle Name:
Last Name:WHEELER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E STATE ROUTE A
Mailing Address - Street 2:
Mailing Address - City:ARCHIE
Mailing Address - State:MO
Mailing Address - Zip Code:64725-9766
Mailing Address - Country:US
Mailing Address - Phone:573-619-2576
Mailing Address - Fax:
Practice Address - Street 1:1 PAYCOR STADIUM
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-3492
Practice Address - Country:US
Practice Address - Phone:573-619-2576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2025-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0071432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer