Healthcare Provider Details

I. General information

NPI: 1528087442
Provider Name (Legal Business Name): JEANETTE MARIE DE WITT PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEANETTE MARIE BRANDT PT, ATC

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7595 BRIDGETOWN RD
CINCINNATI OH
45248-2019
US

IV. Provider business mailing address

7595 BRIDGETOWN RD
CINCINNATI OH
45248-2019
US

V. Phone/Fax

Practice location:
  • Phone: 513-822-5801
  • Fax: 844-605-3317
Mailing address:
  • Phone: 513-822-5801
  • Fax: 844-605-3317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008334
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11903-24
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001071
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1315-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: