| Doctor Name: | MATTHEW WISEHART |
| NPI Number: | 1063861060 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPT |
| License Number: | 12255 |
| Business Practice Address: | 11209 N Tatum Blvd Ste B-120 Phoenix, AZ - 850283091 |
| Business Phone Number: | 6025950204 |
| Business Fax Number: | 6025952168 |
| Mailing Address: | 790 Remington Blvd, BOLINGBROOK |
| State: | IL |
| Postal Code: | 604404909 |
| Phone Number: | 6302962223 |
| Fax Number: | |
| NPI Enumeration Date: | 06/09/2016 |
| NPI Last Update Date: | 06/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 12255 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |