Individual
KEYONA TYESE WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
108 PINE RIDGE DR, BLUFFTON, SC 29910-6815
(843) 338-8644
Mailing address
29 BROWN RD, YEMASSEE, SC 29945-7800
(843) 338-8644
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS5571
SC
Other
Enumeration date
10/08/2020
Last updated
10/08/2020
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