Individual
DANA ELIZABETH WISWALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3308 W EDGEWOOD DR, JEFFERSON CITY, MO 65109-6891
(573) 638-3400
(573) 638-3405
Mailing address
305 JUSTIN LN, ASHLAND, MO 65010-8915
(573) 657-6133
(573) 638-3405
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2003029894
MO
Other
Enumeration date
04/24/2007
Last updated
07/08/2007
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