Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
N | 226300000X | Kinesiotherapist |
NPI | 1720741440 |
---|---|
Provider Name | Sterling Wise |
First Address | Grosse Pointe Woods, MI 48236-1657 |
Second Address | Grosse Pointe Woods, MI 48236-2509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2021 |
Last Update Date | 19/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NA | NO SUCH NUMBERS (01) |