Provider Demographics
NPI:1417034802
Name:WISE, CHRISTOPHER H (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:H
Last Name:WISE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15050 KUTZTOWN RD
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-9275
Mailing Address - Country:US
Mailing Address - Phone:610-683-5686
Mailing Address - Fax:610-683-8773
Practice Address - Street 1:15050 KUTZTOWN RD
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-9275
Practice Address - Country:US
Practice Address - Phone:610-683-5686
Practice Address - Fax:610-683-8773
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007644L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1417034802OtherINTERGROUP
PA50083550OtherCAPITAL BLUE CROSS
PA0716259000OtherPERSONAL CHOICE
PA0716259000OtherAMERIHEALTH
PA1417034802OtherHEALTHNET
PAWI20742OtherHIGHMARK
PA422764OtherHEALTH AMER/HEALTH ASSUR.
PA000020742OtherHIGHMARK BLUE SHIELD
PA1417034802OtherBERKSHIRE HEALTH PLAN EAST
PA1417034802OtherCIGNA
PA0716259000OtherINDEPENDENCE BLUE CROSS
PA1417034802OtherPHCS/MULTIPLAN
PAWI20742OtherHIGHMARK