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NPI Code Detail

MEDICARE: MR. TIMOTHY JAMES WITTENAUER

MEDICARE: MR. TIMOTHY JAMES WITTENAUER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2305004636VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14454125OTHERAETNA
2114481OTHERANTHEM
31985263OTHERFIRST HEALTH

General Provider Information

NPI Number : 1417933953
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY JAMES WITTENAUER
Provider Business Mailing Address
First Line : 108 WALTON PARK LN
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-3028
Country : US
Telephone Number : 804-560-9575
Fax Number : 804-560-9557
Provider Business Practice Location Address
First Line : 108 WALTON PARK LN
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-3028
Country : US
Telephone Number : 804-560-9575
Fax Number : 804-560-9557
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2005
Last Update Date : 07/08/2007

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