Individual
MRS. STEPHANIE L WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, ATC, CSCS
Contact information
Practice address
100 GORE ST., HUNTLAND, TN 37345
(931) 469-7506
Mailing address
185 HOSPITAL RD, WINCHESTER, TN 37398-2404
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0000001148
—
Other
Enumeration date
03/09/2010
Last updated
03/09/2010
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