Provider Demographics
NPI:1912035908
Name:WISE, JULIE (MPT DPT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:WISE
Suffix:
Gender:F
Credentials:MPT DPT
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:ARNOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT DPT
Mailing Address - Street 1:RR 1 BOX 140C
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-9787
Mailing Address - Country:US
Mailing Address - Phone:570-265-7688
Mailing Address - Fax:570-265-7422
Practice Address - Street 1:542 BOULEVARD AVE
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1750
Practice Address - Country:US
Practice Address - Phone:570-489-5010
Practice Address - Fax:570-489-5060
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist