Provider Demographics
NPI:1316108889
Name:WHIELDON, TERRY JOHN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:JOHN
Last Name:WHIELDON
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4063 NORTH BUFFALO ROAD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-662-2949
Mailing Address - Fax:716-662-3673
Practice Address - Street 1:4063 NORTH BUFFALO ROAD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-662-2949
Practice Address - Fax:716-662-3673
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY79921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9352186OtherINDEPENDENT HEALTH
506103111OtherBLUE CROSS OF NY
00011189901OtherUNIVERA
NYA36747Medicare UPIN