Provider Demographics
NPI:1699124271
Name:WISDOM, JEREMIAH (DPT)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:WISDOM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CRESCENT CENTRE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7269
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:5220 PARK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3540
Practice Address - Country:US
Practice Address - Phone:901-683-9630
Practice Address - Fax:901-767-2663
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist