1083954564 NPI number — MRS. SAMANTHA H WHEELER DPT

Table of content: MRS. SAMANTHA H WHEELER DPT (NPI 1083954564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083954564 NPI number — MRS. SAMANTHA H WHEELER DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHEELER
Provider First Name:
SAMANTHA
Provider Middle Name:
H
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHEELER
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083954564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2680 VALLEYDALE RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35244-2023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-981-1690
Provider Business Mailing Address Fax Number:
205-981-1692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2050 VILLAGE DR
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
LEEDS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35094-1107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-640-1088
Provider Business Practice Location Address Fax Number:
205-640-7009
Provider Enumeration Date:
02/21/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PTH6742 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)