MEDICARE: ETHAN CHRISTOPHER WHEELER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer		KY

General Provider Information

NPI Number	:	1033041207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN CHRISTOPHER WHEELER

Provider Business Mailing Address
First Line	:	172 PALISADES PT
Second Line	:
City	:	LANCASTER
State	:	KY
Zip	:	40444-8956
Country	:	US
Telephone Number	:	859-209-1458
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 S LIMESTONE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-3567
Country	:	US
Telephone Number	:	859-323-1100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ ETHAN CHRISTOPHER WHEELER ” Practice Location

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