Healthcare Provider Details

I. General information

NPI: 1639616121
Provider Name (Legal Business Name): CASSANDRA WITTMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 5TH ST
MONROE WI
53566-1546
US

IV. Provider business mailing address

515 22ND AVE
MONROE WI
53566-1569
US

V. Phone/Fax

Practice location:
  • Phone: 608-324-2000
  • Fax: 608-324-2469
Mailing address:
  • Phone: 608-324-2000
  • Fax: 608-324-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number070022754
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: