Provider Demographics
NPI:1396706040
Name:WHEELER, RAYMOND J
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
Last Name:WHEELER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHIP
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:598 SE ESSEX DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5156
Mailing Address - Country:US
Mailing Address - Phone:772-785-6727
Mailing Address - Fax:772-785-6727
Practice Address - Street 1:8423 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3358
Practice Address - Country:US
Practice Address - Phone:772-337-3141
Practice Address - Fax:772-878-1559
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-43483225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist