=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063656189
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA DAWN WITTEKIND PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2009
-----------------------------------------------------
Last Update Date | 04/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2250 HICKORY RD STE 240
-----------------------------------------------------
City | PLYMOUTH MEETING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19462-2225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-834-1122
-----------------------------------------------------
Fax | 610-684-4547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 1/2 PENNSYLVANIA AVE
-----------------------------------------------------
City | FAIRLESS HILLS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19030-1318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-736-3242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | TE1000515
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------