Provider Demographics
NPI:1235490673
Name:WISE, DANNY BRYAN
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:BRYAN
Last Name:WISE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7213 WHISPER HEIGHTS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-4752
Mailing Address - Country:US
Mailing Address - Phone:702-204-8015
Mailing Address - Fax:
Practice Address - Street 1:7213 WHISPER HEIGHTS CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-4752
Practice Address - Country:US
Practice Address - Phone:702-204-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner