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General NPI Number Information
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NPI Number | 1700663705
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Entity Type | Individual
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Provider Name | COLTON WISE DPT
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Gender | Male
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 13238 WALLIN MOUNTAIN RD
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City | WEST FORK
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State | AR
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Zip | 72774-9215
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Country | US
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Telephone | 479-502-5727
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Fax |
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Provider Business Mailing Address
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Address Line | 13238 WALLIN MOUNTAIN RD
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City | WEST FORK
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State | AR
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Zip | 72774-9215
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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 | CP024931T
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License Number State | SC
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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 | 5389
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP052180T
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License Number State | VA
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