Provider Demographics
NPI:1295991594
Name:WISE, LINDA KATHERINE (DPT,MOT,PT,OTR/L)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KATHERINE
Last Name:WISE
Suffix:
Gender:F
Credentials:DPT,MOT,PT,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 KELLY CT
Mailing Address - Street 2:
Mailing Address - City:AMISSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20106-2066
Mailing Address - Country:US
Mailing Address - Phone:540-349-5856
Mailing Address - Fax:
Practice Address - Street 1:500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3027
Practice Address - Country:US
Practice Address - Phone:540-316-2680
Practice Address - Fax:540-316-2681
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004710282NR1301X
VA2305205443282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural