Provider Demographics
NPI:1326703398
Name:WISE, KAREN ANN (PT, DPT, LSVT-BIG)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANN
Last Name:WISE
Suffix:
Gender:F
Credentials:PT, DPT, LSVT-BIG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 MCBRIDE LN
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:VA
Mailing Address - Zip Code:24557-2773
Mailing Address - Country:US
Mailing Address - Phone:434-656-4607
Mailing Address - Fax:
Practice Address - Street 1:291 MCBRIDE LN
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-2773
Practice Address - Country:US
Practice Address - Phone:434-656-4607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist