Wise, Andrea

Wise, Andrea is an individual health care provider with primary practice located at 1709 Caldwell Blvd , Nampa ID 83651-1729. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Wise, Andrea can be contacted via phone (208) 489-4480.

Contact Information

Primary practice address
1709 Caldwell Blvd Nampa ID 83651-1729
Phone: (208) 489-4480
Fax: (208) 489-4073
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X PT-2137 Idaho

Profile Details

NPI number 1275683831
LBN Legal business name Wise, Andrea
Credentials DPT
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 12th, 2007
Last updated Jun 24th, 2013 - about 12 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 1275683831 NPPES
Idaho Other 000010159755 REGENCE BLUE SHIELD
Idaho Other TD413 REGENCE BLUE SHIELD
Idaho MEDICAID 807708700 REGENCE BLUE SHIELD

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