Provider Demographics
NPI:1144355991
Name:WISINSKI, CHERYL MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:MARIE
Last Name:WISINSKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11640 ARBOR ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5007
Mailing Address - Country:US
Mailing Address - Phone:402-933-8383
Mailing Address - Fax:402-933-8382
Practice Address - Street 1:11640 ARBOR ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5007
Practice Address - Country:US
Practice Address - Phone:402-933-8383
Practice Address - Fax:402-933-8382
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE091051Medicare ID - Type Unspecified