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General NPI Number Information
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NPI Number | 1053215657
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Entity Type | Individual
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Provider Name | ERIC DAVID WITTIG
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Gender |
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 1201 MAIN ST
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City | UNION GROVE
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State | WI
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Zip | 53182-1372
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Country | US
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Telephone | 262-878-9602
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Fax |
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Provider Business Mailing Address
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Address Line | 2122 YORK RD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-1925
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | WI
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