MEDICARE: ROBERT WILLIAM WIESE 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	8293	NC

General Provider Information

NPI Number	:	1457432569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT WILLIAM WIESE PT

Provider Business Mailing Address
First Line	:	5920 SANDY FORKS RD STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-3814
Country	:	US
Telephone Number	:	919-954-3492
Fax Number	:

Provider Business Practice Location Address
First Line	:	5920 SANDY FORKS RD STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-3814
Country	:	US
Telephone Number	:	919-954-3492
Fax Number	:

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	05/09/2022

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