Provider Demographics
NPI:1306086335
Name:WHEELER, MARISSA DANIELLE (DPT)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:DANIELLE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:2120 43RD ST SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3772
Mailing Address - Country:US
Mailing Address - Phone:616-281-1144
Mailing Address - Fax:616-281-1221
Practice Address - Street 1:5570 WILSON AVE SW
Practice Address - Street 2:SUITE A.
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1496
Practice Address - Country:US
Practice Address - Phone:616-855-1495
Practice Address - Fax:616-855-1496
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2013-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5501014132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N41100Medicare PIN