Jared M Wise, PT

NPI #1174888275 in Mendota, Illinois

Provider Information

NPI Number: 1174888275
Entity Type: Individual
Name: Jared M Wise, PT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Credential: PT
Enumeration Date: Jul 5, 2012
Last Updated: Jul 5, 2012

Practice Location

Address: 1401 E 12TH ST
City: Mendota
State: Illinois
ZIP Code: 61342-9216
Phone: (815) 539-1409

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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