Individual
ANDREA WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1709 CALDWELL BLVD, NAMPA, ID 83651-1729
(208) 489-4480
(208) 489-4073
Mailing address
1709 CALDWELL BLVD, NAMPA, ID 83651-1729
(208) 489-4480
(208) 489-4073
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2137
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010159755
REGENCE BLUE SHIELD
ID
05
—
807708700
—
ID
01
—
TD413
BLUE CROSS OF IDAHO
ID
Enumeration date
01/12/2007
Last updated
06/24/2013
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