Individual
KELLEY WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
2509 PLEASANT RUN DR, HARRISONBURG, VA 22801-8720
(609) 240-9651
Mailing address
2057 CHANNING DR UNIT 404, ROCKINGHAM, VA 22801-3073
(609) 240-9651
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/02/2017
Last updated
09/30/2020
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