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Individual

BRIAN WISEMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RPT

Contact information

Practice address
115 DEACON TILLER CT, SUITE 2, DUNCAN, SC 29334-8880
(864) 587-1921
(864) 587-9119
Mailing address
115 DEACON TILLER CT, SUITE 2, DUNCAN, SC 29334-8880
(864) 587-1921
(864) 587-9119

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4254
LICENSE #
SC
Enumeration date
08/30/2006
Last updated
03/25/2010
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