Individual
KORRYN WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T., C.M.P.T.
Contact information
Practice address
5856 HARRISON BLVD, SUITE A, SOUTH OGDEN, UT 84403-4397
(801) 475-6415
(801) 475-6417
Mailing address
5856 HARRISON BLVD, SUITE A, SOUTH OGDEN, UT 84403-4397
(801) 475-6415
(801) 475-6417
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
117905-2401
UT
Other
Enumeration date
03/11/2006
Last updated
08/19/2007
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