Healthcare Provider Details

I. General information

NPI: 1861828816
Provider Name (Legal Business Name): BENJAMIN JOSEPH WITTMAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 WINFIELD DUNN PKWY STE 106
KODAK TN
37764
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
BIRMINGHAM AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 865-932-1088
  • Fax: 865-932-1454
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9850
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: