Individual
TERESA D WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4317 BRADFORD DR, CONWAY, SC 29526-2427
(843) 331-7666
Mailing address
4317 BRADFORD DR, CONWAY, SC 29526-2427
(843) 331-7666
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4366
SC
Other
Enumeration date
11/18/2011
Last updated
11/11/2015
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