Provider Demographics
NPI:1437630001
Name:WHEELER, COURTNEY LAUREN (DPT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LAUREN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 COFFEE RD STE I
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3164
Mailing Address - Country:US
Mailing Address - Phone:209-576-0888
Mailing Address - Fax:209-576-0913
Practice Address - Street 1:4052 MOTHER LODE DR
Practice Address - Street 2:
Practice Address - City:SHINGLE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95682-8491
Practice Address - Country:US
Practice Address - Phone:530-677-5092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24722225100000X
MD27174225100000X
CAPT296671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty