Healthcare Provider Details

I. General information

NPI: 1013709591
Provider Name (Legal Business Name): ZACHARY DAVID WISKOW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 OLEANDER DR STE 200
WILMINGTON NC
28403-4813
US

IV. Provider business mailing address

PO BOX 5105
BELFAST ME
04915-5100
US

V. Phone/Fax

Practice location:
  • Phone: 919-790-9714
  • Fax: 910-791-1063
Mailing address:
  • Phone: 919-220-5255
  • Fax: 919-220-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP24066
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: