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NPI Code Detail

MEDICARE: JAMES R WISE RPT

MEDICARE: JAMES R WISE RPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1364SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11364OTHERSDSD LICENSE

General Provider Information

NPI Number : 1841479599
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES R WISE RPT
Provider Business Mailing Address
First Line : PO BOX 3450
Second Line :
City : RAPID CITY
State : SD
Zip : 57709-3450
Country : US
Telephone Number : 605-892-3331
Fax Number :
Provider Business Practice Location Address
First Line : 2200 13TH AVE
Second Line :
City : BELLE FOURCHE
State : SD
Zip : 57717-2215
Country : US
Telephone Number : 605-892-3331
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2007
Last Update Date : 10/30/2007

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