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General NPI Number Information
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NPI Number | 1629142823
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Entity Type | Individual
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Provider Name | JERRY DANIEL WHEAT ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3700 W BERRY LUPTON STADIUM
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City | FORT WORTH
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State | TX
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Zip | 76129-0001
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Country | US
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Telephone | 817-257-5156
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Fax |
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Provider Business Mailing Address
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Address Line | 2109 LINCOLN CT
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City | FLOWER MOUND
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State | TX
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Zip | 75028-8363
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Country | US
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Telephone | 972-691-2625
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0329
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License Number State | TX
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