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General NPI Number Information
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NPI Number | 1407414964
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Entity Type | Individual
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Provider Name | AARON JACOB WITZ LMT
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Gender | Male
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 05/30/2019
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Provider Practice Location Address
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Address Line | 453 DUNHAM RD STE 200
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City | ST CHARLES
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State | IL
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Zip | 60174-1451
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Country | US
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Telephone | 314-315-1479
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Fax |
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Provider Business Mailing Address
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Address Line | 650 CARROLL SQ APT 6
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-1546
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Country | US
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Telephone | 847-922-8028
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 22714676
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License Number State | IL
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