Individual
MR. STEPHEN THEODORE WIESKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02503
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0263731
—
IA
01
—
349984700
US DEPT OF LABOR WORK COM
IA
01
—
49799
WELLMARK
IA
Enumeration date
07/19/2006
Last updated
03/30/2018
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