Individual
JEREMY WIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(800) 728-8808
Mailing address
PO BOX 656, ETOWAH, NC 28729-0656
(828) 691-0300
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A3567
NC
Other
Enumeration date
08/10/2023
Last updated
08/10/2023
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