Individual
SUSAN WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4252 BONITA RD, #306, BONITA, CA 91902-1420
(505) 860-7065
Mailing address
4252 BONITA RD, #306, BONITA, CA 91902-1420
(505) 860-7065
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT 5529
CA
Other
Enumeration date
07/09/2008
Last updated
07/09/2008
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