Individual
ANDREW WIETING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2424 S 90TH ST STE 500, WEST ALLIS, WI 53227-2464
(414) 321-2255
(414) 321-2091
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
13891
WI
225100000X
Physical Therapist
Primary
13891
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100159406
—
WI
Enumeration date
04/21/2020
Last updated
04/16/2024
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