Provider Demographics
NPI:1013140755
Name:WISNOWSKI, SHELLEY JO (PT)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:JO
Last Name:WISNOWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:JO
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:91 CHAMPION CLIFF
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4874
Mailing Address - Country:US
Mailing Address - Phone:210-842-9720
Mailing Address - Fax:210-497-6848
Practice Address - Street 1:91 CHAMPION CLIFF
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4874
Practice Address - Country:US
Practice Address - Phone:210-842-9720
Practice Address - Fax:210-497-6848
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1181250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist