Healthcare Provider Details

I. General information

NPI: 1457155137
Provider Name (Legal Business Name): AUSTIN WITT M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 W SAINT VRAIN ST
COLORADO SPRINGS CO
80904-3567
US

IV. Provider business mailing address

1702 W SAINT VRAIN ST
COLORADO SPRINGS CO
80904-3567
US

V. Phone/Fax

Practice location:
  • Phone: 319-461-6277
  • Fax:
Mailing address:
  • Phone: 319-461-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: