MEDICARE: MATTHEW WISEMAN DPT,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	PT-3831	ID
2	225100000X	Physical Therapist	10358145-2401	UT
3	225100000X	Physical Therapist	1394746	TX

General Provider Information

NPI Number	:	1184929168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW WISEMAN DPT,PT

Provider Business Mailing Address
First Line	:	29615 FM 1093 RD STE 2
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-3926
Country	:	US
Telephone Number	:	281-533-0507
Fax Number	:	281-533-0521

Provider Business Practice Location Address
First Line	:	29615 FM 1093 RD STE 2
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-3926
Country	:	US
Telephone Number	:	281-533-0507
Fax Number	:	281-533-0521

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

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	03/11/2026

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