Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 12616APTA | AZ |
N | 225200000X | Physical Therapy Assistant | A03531 | KY |
NPI | 1013424365 |
---|---|
Provider Name | Chelsie Wise |
First Address | Chandler, AZ 85249-5600 |
Second Address | Chandler, AZ 85248-4510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2018 |
Last Update Date | 17/03/2018 |