Individual
REGINALD THOMAS WHEATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
12 S LAKEVIEW CT, GODDARD, KS 67052-9228
(316) 252-0445
Mailing address
12 S LAKEVIEW CT, GODDARD, KS 67052-9228
(316) 252-0445
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14-01922
KANSAS STATE LICENSE
KS
Enumeration date
10/29/2021
Last updated
11/04/2021
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