Healthcare Provider Details

I. General information

NPI: 1376185553
Provider Name (Legal Business Name): DENISE M WISE LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 NORTH AVENUE G
CLIFTON TX
76634-7663
US

IV. Provider business mailing address

7125 NEW SANGER AVE STE 502
WACO TX
76712-4054
US

V. Phone/Fax

Practice location:
  • Phone: 254-675-2554
  • Fax: 254-675-4063
Mailing address:
  • Phone: 254-732-5981
  • Fax: 254-754-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1109668
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: