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General NPI Number Information
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NPI Number | 1013709591
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Entity Type | Individual
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Provider Name | ZACHARY DAVID WISKOW
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Gender | Male
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 6019 OLEANDER DR STE 200
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City | WILMINGTON
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State | NC
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Zip | 28403-4813
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Country | US
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Telephone | 919-790-9714
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Fax | 910-791-1063
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Provider Business Mailing Address
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Address Line | PO BOX 5105
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City | BELFAST
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State | ME
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Zip | 04915-5100
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Country | US
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Telephone | 919-220-5255
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Fax | 919-220-6971
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P24066
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License Number State | NC
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