Active NPI
Mitchell Vaughn Wheeler, PTA
- Physical Therapy Assistant
- Caribou, ME
National Provider Identifier
1750923942
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PA4867
- Practice address
- 163 Van Buren Rd
Caribou, ME 04736-3567 - Phone
- (207) 498-1618
- Fax
- (207) 498-1653
- NPI assigned
- Oct 9, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PA4867 | ME | Primary |
Addresses
Primary practice location
163 Van Buren Rd
Caribou, ME 04736-3567
Mailing address
163 Van Buren Rd Ste 1
Caribou, ME 04736-3567
Phone (207) 498-1618
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA4867 | ME | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570579200000",
"number": "1750923942",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "163 VAN BUREN RD STE 1",
"city": "CARIBOU",
"state": "ME",
"postal_code": "047363567",
"telephone_number": "207-498-1618",
"fax_number": "207-498-1653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "163 VAN BUREN RD",
"city": "CARIBOU",
"state": "ME",
"postal_code": "047363567",
"telephone_number": "207-498-1618",
"fax_number": "207-498-1653"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHEELER",
"first_name": "MITCHELL",
"middle_name": "VAUGHN",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-09",
"last_updated": "2019-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "ME",
"license": "PA4867",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Caribou, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.