Healthcare Provider Details

I. General information

NPI: 1689119067
Provider Name (Legal Business Name): CHAD DAVID WOITAS PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 02/18/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HOSPITAL RD
FORT EISENHOWER GA
30905-5741
US

IV. Provider business mailing address

300 EAST HOSPITAL ROAD
FORT EISENHOWER GA
30905
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-5373
  • Fax:
Mailing address:
  • Phone: 706-787-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017553
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT33322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: