Provider Demographics
NPI:1013520600
Name:WISNIEWSKI, RACHEL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34669
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-0669
Mailing Address - Country:US
Mailing Address - Phone:402-932-6791
Mailing Address - Fax:402-614-7835
Practice Address - Street 1:555 CORNHUSKER RD
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-7909
Practice Address - Country:US
Practice Address - Phone:402-614-4300
Practice Address - Fax:402-614-5211
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4381225100000X
MI5501019696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist