Provider Demographics
NPI:1942174701
Name:WISOR, FAITH (PT, DPT)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:WISOR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:
Other - Last Name:BROUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:238 E CRAIG PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3546
Mailing Address - Country:US
Mailing Address - Phone:210-429-3683
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1407520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist