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Individual
BRIAN R. WILEY
Active
Individual
BRIAN R. WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4676
SC
261QP2000X
Physical Therapy Clinic/Center
4676
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4676
PT LICENSE #
SC
01
—
861168971
EMPLOYER ID#
SC
Enumeration date
03/08/2006
Last updated
03/20/2025
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