Healthcare Provider Details

I. General information

NPI: 1275695579
Provider Name (Legal Business Name): CYNTHIA WITTE L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7033 ALEXANDRIA PIKE
ALEXANDRIA KY
41001-1031
US

IV. Provider business mailing address

2398 S MAIN AVE
HIGHLAND HEIGHTS KY
41076-1209
US

V. Phone/Fax

Practice location:
  • Phone: 859-635-6666
  • Fax: 859-635-6607
Mailing address:
  • Phone: 859-628-9496
  • Fax: 859-635-6607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberKY-1616
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: