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Organization

WISE PHYSICAL THERAPY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CHRISTOPHER H. WISE PT (PRESIDENT)
(610) 308-8934
Entity
Organization

Contact information

Practice address
15050 KUTZTOWN RD, KUTZTOWN, PA 19530-9275
(610) 683-5686
(610) 683-8773
Mailing address
23 NANCY CIR, READING, PA 19606-8943
(610) 308-8934

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT007644L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0716259000
INDEPENDENCE BLUE CROSS
PA
01
11908776
CAQH
PA
01
1417034802
INDIVIDUAL NPI
PA
01
422764
HEALTH AMERICA, HEALTH ASSURANCE
PA
01
50083540
CAPITAL BLUE CROSS
01
WI20742
HIGHMARK
PA
Enumeration date
04/17/2012
Last updated
04/17/2012
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