Provider Demographics
NPI:1134453467
Name:WIESNER, PAUL J (DPT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:J
Last Name:WIESNER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:1111 MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-2074
Mailing Address - Country:US
Mailing Address - Phone:707-287-4437
Mailing Address - Fax:707-286-5506
Practice Address - Street 1:1111 MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-2074
Practice Address - Country:US
Practice Address - Phone:707-287-4437
Practice Address - Fax:707-286-5506
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist