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General NPI Number Information
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NPI Number | 1851614606
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Entity Type | Individual
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Provider Name | STEPHANIE L WISE MS, ATC, CSCS
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Gender | Female
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Dates
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Enumeration Date | 03/09/2010
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Last Update Date | 03/09/2010
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Provider Practice Location Address
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Address Line | 100 GORE ST.
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City | HUNTLAND
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State | TN
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Zip | 37345
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Country | US
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Telephone | 931-469-7506
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Fax |
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Provider Business Mailing Address
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Address Line | 185 HOSPITAL RD
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City | WINCHESTER
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State | TN
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Zip | 37398-2404
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0000001148
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License Number State |
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