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General NPI Number Information
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NPI Number | 1457117731
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Entity Type | Individual
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Provider Name | MRS. VICKI LYNNE WIESEL
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Gender | Female
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 12 GAMELIN ST
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City | HOLYOKE
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State | MA
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Zip | 01040-4080
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Country | US
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Telephone | 413-420-2512
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Fax |
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Provider Business Mailing Address
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Address Line | 50 KENDALL ST
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City | GRANBY
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State | MA
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Zip | 01033-9510
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Country | US
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Telephone | 413-537-1302
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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 | PTL13382
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License Number State | MA
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