Provider Demographics
NPI:1023876190
Name:WISE ORTHOPEDIC PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:WISE ORTHOPEDIC PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:818-300-7679
Mailing Address - Street 1:26 COURT ST STE 809
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11242-1108
Mailing Address - Country:US
Mailing Address - Phone:929-266-6768
Mailing Address - Fax:866-740-0648
Practice Address - Street 1:26 COURT ST STE 809
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1108
Practice Address - Country:US
Practice Address - Phone:929-266-6768
Practice Address - Fax:866-740-0648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy