Provider Demographics
NPI:1821323288
Name:WISNOSKY, JO ELLEN (LICAC, CMT)
Entity Type:Individual
Prefix:
First Name:JO ELLEN
Middle Name:
Last Name:WISNOSKY
Suffix:
Gender:F
Credentials:LICAC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 COLONIAL MANOR DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-6032
Mailing Address - Country:US
Mailing Address - Phone:717-723-1362
Mailing Address - Fax:
Practice Address - Street 1:1624 COLONIAL MANOR DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-6032
Practice Address - Country:US
Practice Address - Phone:717-723-1362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000973171100000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist