Provider Demographics
NPI:1346613437
Name:WISE, JONATHAN BIRCHLER (DPT, PT, MS, ATC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BIRCHLER
Last Name:WISE
Suffix:
Gender:M
Credentials:DPT, PT, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13643 BRICK PATH
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-2471
Mailing Address - Country:US
Mailing Address - Phone:608-963-9526
Mailing Address - Fax:
Practice Address - Street 1:3800 AMERICAN BLVD W # 200
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-4420
Practice Address - Country:US
Practice Address - Phone:952-831-8742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002462A2255A2300X
MN127452251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer