Individual
JIMMY DOUGLAS WHEELER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
124 PETERSEN PARKWAY, #1, THAYNE, WY 83127
(307) 883-7878
(307) 883-7877
Mailing address
124 PETERSEN PARKWAY #5, THAYNE, WY 83127
(307) 883-7878
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
WY-78
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103956300
—
WY
Enumeration date
07/20/2006
Last updated
07/09/2007
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