Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2305204478 | VA |
NPI | 1124353792 |
---|---|
Provider Name | Ms. Susan Caulfield Wise |
First Address | Springfield, VA 22153-1302 |
Second Address | Springfield, VA 22153-1302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2009 |
Last Update Date | 14/10/2009 |