Healthcare Provider Details

I. General information

NPI: 1548187628
Provider Name (Legal Business Name): PAUL EDWARD WITTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3047 WILLIAM ST STE 100
CAPE GIRARDEAU MO
63703-6569
US

IV. Provider business mailing address

3047 WILLIAM ST STE 100
CAPE GIRARDEAU MO
63703-6569
US

V. Phone/Fax

Practice location:
  • Phone: 573-339-5989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13004
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: