Healthcare Provider Details

I. General information

NPI: 1538334321
Provider Name (Legal Business Name): JUDITH G. WISNIA MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S MAIN ST
YARDLEY PA
19067-1510
US

IV. Provider business mailing address

520 PHILADELPHIA ST
INDIANA PA
15701-3902
US

V. Phone/Fax

Practice location:
  • Phone: 215-493-1889
  • Fax: 215-493-2164
Mailing address:
  • Phone: 724-463-7478
  • Fax: 724-463-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT003091E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: