Individual
JASON WHEATLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
10529 SOUTH RIVA RIDGE LOOP, FORT DRUM, NY 13602
(315) 774-8155
Mailing address
122 WHITE SPRINGS RD, GENEVA, NY 14456-3018
(315) 719-3070
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/23/2021
Last updated
09/07/2022
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