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General NPI Number Information
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NPI Number | 1598609943
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Entity Type | Individual
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Provider Name | BRENDA FULLICK WISE LMT
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Gender | Female
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Dates
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Enumeration Date | 04/16/2026
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Last Update Date | 04/16/2026
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Provider Practice Location Address
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Address Line | 109 1/2 N 2ND AVE
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City | WINTERSET
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State | IA
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Zip | 50273-1657
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Country | US
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Telephone | 515-468-5533
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Fax |
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Provider Business Mailing Address
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Address Line | 2478 MILLSTREAM AVE
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City | WINTERSET
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State | IA
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Zip | 50273-8124
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Country | US
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Telephone | 515-468-5533
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 006250
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License Number State | IA
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