Healthcare Provider Details

I. General information

NPI: 1679671069
Provider Name (Legal Business Name): CHRISTINE F WISMER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S SAINT FRANCIS DR #5
SANTA FE NM
87501-2454
US

IV. Provider business mailing address

29 DOMINGO RD
SANTA FE NM
87508-8256
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-8561
  • Fax: 505-989-1740
Mailing address:
  • Phone: 505-231-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1265
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: