| NPI | 1053691576 |
|---|---|
| Former Name | COUTNEY WISEMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11211324-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 11313) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2022-12-31 |