Wisdom, Kevin

Wisdom, Kevin is an individual health care provider with primary practice located at 3317 N Wimberly Dr , Fayetteville AR 72703-4056. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Wisdom, Kevin can be contacted via phone (479) 521-2752.

Contact Information

Primary practice address
3317 N Wimberly Dr Fayetteville AR 72703-4056
Phone: (479) 521-2752
Fax: (479) 444-6942
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X PT2490 Arkansas

Profile Details

NPI number 1063485670
LBN Legal business name Wisdom, Kevin
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 13th, 2006
Last updated Dec 14th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063485670 NPPES
Arkansas Other P00162005 RAILROAD MEDICARE

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