Individual
MR. MARK W WISENOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
3720 S INDIANA AVE, CALDWELL, ID 83605-6457
(208) 459-6041
(208) 459-0346
Mailing address
3720 S INDIANA AVE, CALDWELL, ID 83605-6457
(208) 459-6041
(208) 459-0346
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1455
ID
Other
Enumeration date
06/19/2008
Last updated
06/19/2008
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