Provider Demographics
NPI:1780948570
Name:WIZE, TRESA LYNNE (DPM)
Entity type:Individual
Prefix:DR
First Name:TRESA
Middle Name:LYNNE
Last Name:WIZE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 BEANER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-9723
Mailing Address - Country:US
Mailing Address - Phone:724-775-4242
Mailing Address - Fax:
Practice Address - Street 1:1030 BEANER HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9723
Practice Address - Country:US
Practice Address - Phone:724-775-4242
Practice Address - Fax:724-775-4960
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006397213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103117126Medicaid