| Doctor Name: | MISS LAURIE ANN WIESE |
| NPI Number: | 1073688875 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 021047 |
| Business Practice Address: | 790 Ayrault Rd Fairport, NY - 14450 |
| Business Phone Number: | 5854251018 |
| Business Fax Number: | 5854258955 |
| Mailing Address: | 790 Ayrault Rd, FAIRPORT |
| State: | NY |
| Postal Code: | 14450 |
| Phone Number: | 5854251018 |
| Fax Number: | 5854258955 |
| NPI Enumeration Date: | 11/21/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 021047 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |