MEDICARE: JOEL WITTMAN DPT

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
1	2251X0800X	Orthopedic Physical Therapist	PT30605	FL

General Provider Information

NPI Number	:	1962877746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL WITTMAN DPT

Provider Business Mailing Address
First Line	:	2530 BOBCAT VILLAGE CENTER RD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8475
Country	:	US
Telephone Number	:	941-426-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2530 BOBCAT VILLAGE CENTER RD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8475
Country	:	US
Telephone Number	:	941-426-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2015
Last Update Date	:	12/05/2015

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