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General NPI Number Information
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NPI Number | 1366837064
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Entity Type | Individual
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Provider Name | MARY WISEMAN PT, DPT, GCS
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Gender | Female
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 8367 REXTOWN RD
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City | SLATINGTON
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State | PA
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Zip | 18080-3463
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Country | US
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Telephone | 484-624-1566
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Fax |
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Provider Business Mailing Address
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Address Line | 8367 REXTOWN RD
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City | SLATINGTON
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State | PA
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Zip | 18080-3463
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Country | US
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Telephone |
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Fax |
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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 | PT023632
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01551800
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License Number State | NJ
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