Healthcare Provider Details

I. General information

NPI: 1629994918
Provider Name (Legal Business Name): WITMER MOBILE PHYSIO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23160 FASHION DR
ESTERO FL
33928-2559
US

IV. Provider business mailing address

23160 FASHION DR STE 217
ESTERO FL
33928-2567
US

V. Phone/Fax

Practice location:
  • Phone: 850-545-3099
  • Fax:
Mailing address:
  • Phone: 850-545-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LUCAS WITMER
Title or Position: OWNER
Credential: DPT
Phone: 850-545-3099