Individual
BLAKE WISEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
890 E 116TH ST, SUITE 142, CARMEL, IN 46032-3475
(317) 688-8232
(866) 512-2250
Mailing address
13426 LOST CREEK LN, CARMEL, IN 46074-5836
(317) 989-3578
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05009661A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201186570
—
IN
Enumeration date
07/09/2012
Last updated
09/24/2014
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