Healthcare Provider Details

I. General information

NPI: 1851716237
Provider Name (Legal Business Name): PAUL ALAN WHEELER III MS, ATC, LAT, CES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6935 E GOLD DUST AVE
SCOTTSDALE AZ
85253-1447
US

IV. Provider business mailing address

1219 E KERRY LN
PHOENIX AZ
85024-2344
US

V. Phone/Fax

Practice location:
  • Phone: 480-484-6500
  • Fax:
Mailing address:
  • Phone: 602-290-2795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATR-000980
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: