Individual
DR. JILLIAN WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT, LAT, ATC
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2305216542
VA
225100000X
Physical Therapist
Primary
CP031972T
DC
2255A2300X
Athletic Trainer
0126004043
VA
Other
Enumeration date
11/27/2023
Last updated
06/10/2024
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