Provider Demographics
NPI:1811441843
Name:WHEELER, DOROTHY ALICIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ALICIA
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:ALICIA
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1004 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-2310
Mailing Address - Country:US
Mailing Address - Phone:843-310-9690
Mailing Address - Fax:800-317-9690
Practice Address - Street 1:1004 10TH ST
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2310
Practice Address - Country:US
Practice Address - Phone:843-310-9690
Practice Address - Fax:800-317-9690
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6283OtherPROFESSIONAL LICENSE