Healthcare Provider Details

I. General information

NPI: 1780013482
Provider Name (Legal Business Name): MARY HEATHER WHEATLEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 BUENA VISTA DR
NEW CASTLE DE
19720-4660
US

IV. Provider business mailing address

32 BUENA VISTA DR
NEW CASTLE DE
19720-4660
US

V. Phone/Fax

Practice location:
  • Phone: 302-328-2580
  • Fax:
Mailing address:
  • Phone: 302-328-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0000876
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: