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Individual

SUSAN CALLOWAY WHEELER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PTDPTPCS

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
1898
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
079NH
BCBS IDENTIFICATION NUMBE
NC
05
3403400
NC
01
562033116
TRICARE-TAX ID
NC
Enumeration date
01/25/2007
Last updated
11/03/2008
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