Provider Demographics
NPI:1477663375
Name:WISEMAN, BRIAN (RPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WISEMAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 DEACON TILLER CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-8880
Mailing Address - Country:US
Mailing Address - Phone:864-587-1921
Mailing Address - Fax:864-587-9119
Practice Address - Street 1:115 DEACON TILLER CT
Practice Address - Street 2:SUITE 2
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-8880
Practice Address - Country:US
Practice Address - Phone:864-587-1921
Practice Address - Fax:864-587-9119
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4254OtherLICENSE #