MEDICARE: MRS. CHRISTELLE WISE

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
1	225100000X	Physical Therapist	PTA17065	FL

General Provider Information

NPI Number	:	1932055126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTELLE WISE

Provider Business Mailing Address
First Line	:	3131 SE CANBY RD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5860
Country	:	US
Telephone Number	:	772-418-0342
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 SE CANBY RD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5860
Country	:	US
Telephone Number	:	772-418-0342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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