Individual
KIMBERLY WIESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.H.S., P. T.
Contact information
Practice address
2625 E SAINT LOUIS AVE, LAS VEGAS, NV 89104-4200
(702) 799-7463
Mailing address
1636 PALMALES CT, LAS VEGAS, NV 89128-3238
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
499
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100508889
—
NV
Enumeration date
01/08/2007
Last updated
12/07/2009
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