Provider Demographics
NPI:1861601254
Name:WISNIEWSKI, ANITA RAE (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:RAE
Last Name:WISNIEWSKI
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 1:69 W CEDAR ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1351
Mailing Address - Country:US
Mailing Address - Phone:845-797-4797
Mailing Address - Fax:
Practice Address - Street 1:69 W CEDAR ST
Practice Address - Street 2:SUITE 3
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1351
Practice Address - Country:US
Practice Address - Phone:845-797-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0201191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0201191OtherPT