Healthcare Provider Details

I. General information

NPI: 1114954781
Provider Name (Legal Business Name): LYNDSAY GAIL WHEELER MS, ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N JEFFRIES ST
MEXICO MO
65265-3126
US

IV. Provider business mailing address

2700 FEATHER RUN TRL A7
WEST COLUMBIA SC
29169-4966
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-7126
  • Fax:
Mailing address:
  • Phone: 803-467-7912
  • Fax: 803-786-3868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number595
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: