Individual
SAMANTHA WAMBLES WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
303 N HURSTBOURNE PKWY STE 200, LOUISVILLE, KY 40222-5158
(502) 412-5847
Mailing address
765 HICKMAN AVE E, KINSTON, AL 36453-3414
(334) 897-8265
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA5120
AL
Other
Enumeration date
01/04/2013
Last updated
01/04/2013
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