Individual
JAMES R WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
2200 13TH AVE, BELLE FOURCHE, SD 57717-2215
(605) 892-3331
Mailing address
PO BOX 3450, RAPID CITY, SD 57709-3450
(605) 892-3331
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1364
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1364
SD LICENSE
SD
Enumeration date
10/30/2007
Last updated
10/30/2007
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