Individual
MR. JON M WIESELER
Active
Individual
MR. JON M WIESELER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
546
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10024973400
—
NE
01
—
39616
BCBS
NE
01
—
CK7267
RR MEDICARE
NE
Enumeration date
12/26/2006
Last updated
07/08/2007
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