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General NPI Number Information
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NPI Number | 1861029670
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Entity Type | Individual
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Provider Name | WISLYNE JEAN-PIERRE
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Gender | Male
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 5535 S WILLIAMSON BLVD STE 774
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City | PORT ORANGE
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State | FL
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Zip | 32128-8321
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Country | US
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Telephone | 888-265-2680
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Fax |
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Provider Business Mailing Address
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Address Line | 9549 NW 53RD ST
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City | SUNRISE
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State | FL
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Zip | 33351-7700
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA27557
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A4807
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License Number State | MD
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