Healthcare Provider Details

I. General information

NPI: 1114291259
Provider Name (Legal Business Name): RUDOLPH M WITTKUGEL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 JR HIGH SCHOOL RD
SCOTLAND NECK NC
27874-1219
US

IV. Provider business mailing address

921 JR HIGH SCHOOL RD
SCOTLAND NECK NC
27874-1219
US

V. Phone/Fax

Practice location:
  • Phone: 252-826-4144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP13454
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: