Healthcare Provider Details

I. General information

NPI: 1114573359
Provider Name (Legal Business Name): TESSA MARIE WISNIEWSKI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LOVE LN
SOUTH DENNIS MA
02660-3445
US

IV. Provider business mailing address

80 THOMPSON RD
ROCHESTER NY
14623-4755
US

V. Phone/Fax

Practice location:
  • Phone: 508-385-6034
  • Fax:
Mailing address:
  • Phone: 585-683-1563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24368
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: