Healthcare Provider Details

I. General information

NPI: 1841835089
Provider Name (Legal Business Name): ERIC WHEELER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96279 BRADY POINT RD STE B
FERNANDINA BEACH FL
32034-7076
US

IV. Provider business mailing address

96279 BRADY POINT RD STE B
FERNANDINA BEACH FL
32034-7076
US

V. Phone/Fax

Practice location:
  • Phone: 904-261-7878
  • Fax: 904-261-8466
Mailing address:
  • Phone: 904-261-7878
  • Fax: 904-261-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT35314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: