Provider Demographics
NPI:1942578588
Name:WISELEY, BRIDGET ALISE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ALISE
Last Name:WISELEY
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 ROLLING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-2633
Mailing Address - Country:US
Mailing Address - Phone:610-543-7766
Mailing Address - Fax:
Practice Address - Street 1:308 ROLLING CREEK RD
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-2633
Practice Address - Country:US
Practice Address - Phone:610-543-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-11
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0042342255A2300X
DEJ300004022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE22OtherRESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS