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NPI Code Detail

MEDICARE: GLEN SLAYTON WHEELER PT, LMT

MEDICARE: GLEN SLAYTON WHEELER PT, LMT
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
1225100000XPhysical Therapist2305005371VA

General Provider Information

NPI Number : 1205131638
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLEN SLAYTON WHEELER PT, LMT
Provider Business Mailing Address
First Line : 2726 ELECTRIC RD STE 101
Second Line :
City : ROANOKE
State : VA
Zip : 24018-3528
Country : US
Telephone Number : 540-989-8974
Fax Number : 540-989-4695
Provider Business Practice Location Address
First Line : 2726 ELECTRIC RD STE 101
Second Line :
City : ROANOKE
State : VA
Zip : 24018-3528
Country : US
Telephone Number : 540-989-8974
Fax Number : 540-989-4695
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2011
Last Update Date : 01/15/2011

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