Provider Demographics
NPI:1255800033
Name:WISNIEWSKI, ADRIANA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANA
Middle Name:
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 W OAKDALE AVE UNIT I
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4055
Mailing Address - Country:US
Mailing Address - Phone:708-691-2670
Mailing Address - Fax:
Practice Address - Street 1:1366 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2129
Practice Address - Country:US
Practice Address - Phone:773-248-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.008450225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL160.008450OtherLICENSED PHYSICAL THERAPIST ASSISTANT