Individual
BRIAN R. WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2180 PICKENS ST APT 429, COLUMBIA, SC 29201-2786
(803) 917-1878
Mailing address
2180 PICKENS ST APT 429, COLUMBIA, SC 29201-2786
(803) 917-1878
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4676
SC
261QP2000X
Physical Therapy Clinic/Center
4676
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4676
PT LICENSE #
SC
01
—
861168971
EMPLOYER ID#
SC
Enumeration date
03/08/2006
Last updated
03/20/2025
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