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General NPI Number Information
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NPI Number | 1124385042
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Entity Type | Organization
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Legal Business Name | WISE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/17/2012
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Last Update Date | 04/17/2012
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Provider Practice Location Address
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Address Line | 15050 KUTZTOWN RD
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City | KUTZTOWN
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State | PA
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Zip | 19530-9275
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Country | US
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Telephone | 610-683-5686
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Fax | 610-683-8773
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Provider Business Mailing Address
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Address Line | 23 NANCY CIR
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City | READING
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State | PA
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Zip | 19606-8943
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Country | US
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Telephone | 610-308-8934
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER H. WISE
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Credential | PT
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Telephone | 610-308-8934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT007644L
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License Number State | PA
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