Healthcare Provider Details

I. General information

NPI: 1285789347
Provider Name (Legal Business Name): MS. MELINDA WHEELER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 MCFARLAND BLVD E SUITE 209
TUSCALOOSA AL
35404-5805
US

IV. Provider business mailing address

2002 MCFARLAND BLVD E SUITE 209
TUSCALOOSA AL
35404-5805
US

V. Phone/Fax

Practice location:
  • Phone: 205-752-0476
  • Fax: 205-752-8122
Mailing address:
  • Phone: 205-752-0476
  • Fax: 205-752-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTH2409
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: