Healthcare Provider Details

I. General information

NPI: 1295657385
Provider Name (Legal Business Name): ASHTON WISNESKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 WESTDALE PKWY SW STE 300
CEDAR RAPIDS IA
52404-9201
US

IV. Provider business mailing address

8 OAKLEY DR
LE CLAIRE IA
52753-8008
US

V. Phone/Fax

Practice location:
  • Phone: 319-396-0222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number138789
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: