Individual
KONRAD WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3538 CALUMET AVE, VALPARAISO, IN 46383-2246
(219) 316-7470
(219) 386-2505
Mailing address
23 PAISLEY GRN, VALPARAISO, IN 46385-9277
(219) 263-9391
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06007026A
IN
Other
Enumeration date
11/03/2025
Last updated
11/03/2025
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