Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT008218L | PA |
N | 2251S0007X | Physical Therapist - Sports | PT008218L | PA |
NPI | 1336155365 |
---|---|
Provider Name | Dr. Scott Allan Wise |
First Address | Grove City, PA 16127-4550 |
Second Address | Grove City, PA 16127-4629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/02/2020 |