MEDICARE: MRS. STEPHANIE DAWN WHEELER PT

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	225100000X	Physical Therapist	1114791	TX

General Provider Information

NPI Number	:	1801193552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE DAWN WHEELER PT

Provider Business Mailing Address
First Line	:	318 EDGEWOOD ST
Second Line	:
City	:	KRUM
State	:	TX
Zip	:	76249-5128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 PETERS COLONY RD
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-2949
Country	:	US
Telephone Number	:	214-513-0310
Fax Number	:

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

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	02/15/2011

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