Healthcare Provider Details

I. General information

NPI: 1083070528
Provider Name (Legal Business Name): AIMEE C DEWITT B.S., LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N 20TH ST
OPELIKA AL
36801-5449
US

IV. Provider business mailing address

515 ARBOR RIDGE LN
TITUSVILLE FL
32780-1904
US

V. Phone/Fax

Practice location:
  • Phone: 334-749-8303
  • Fax:
Mailing address:
  • Phone: 321-704-5409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1684
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: