Doctor Name: | KAMELIA LEANDRA WISE |
NPI Number: | 1588981153 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | 5501015166 |
Business Practice Address: | 24345 Harper Ave Saint Clair Shores, MI - 480801285 |
Business Phone Number: | 5865633300 |
Business Fax Number: | 5865633313 |
Mailing Address: | 20251 Stotter St, DETROIT |
State: | MI |
Postal Code: | 482343192 |
Phone Number: | 2029047555 |
Fax Number: | |
NPI Enumeration Date: | 04/22/2010 |
NPI Last Update Date: | 11/02/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 5501015166 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
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 |