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General NPI Number Information
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NPI Number | 1174028237
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Entity Type | Individual
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Provider Name | CARISSA NOELLE WITTENBACH DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 4700 LEBANON RD STE D2
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City | MINT HILL
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State | NC
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Zip | 28227-8265
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Country | US
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Telephone | 704-366-7723
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Fax |
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Provider Business Mailing Address
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Address Line | 580 EARLEY ST
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City | KANNAPOLIS
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State | NC
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Zip | 28083-9207
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Country | US
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Telephone | 571-239-3610
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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 | P21321
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | LAT-4668
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License Number State | NC
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