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General NPI Number Information
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NPI Number | 1386024479
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Entity Type | Individual
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Provider Name | NAN MARY WITZGALL P.T.
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Gender | Female
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 1235 S CENTER RD UNIT 12
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City | BURTON
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State | MI
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Zip | 48509-1700
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Country | US
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Telephone | 810-743-8820
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Fax | 810-743-5908
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Provider Business Mailing Address
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Address Line | 824 S ADELAIDE ST
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City | FENTON
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State | MI
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Zip | 48430-2202
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Country | US
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Telephone | 810-845-4538
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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 | 5501003078
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License Number State | MI
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