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General NPI Number Information
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NPI Number | 1437779865
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Entity Type | Individual
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Provider Name | KEIRA WITTLE MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 1118 W BALTIMORE PIKE FL 3
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City | MEDIA
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State | PA
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Zip | 19063-6104
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Country | US
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Telephone | 800-321-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 5542 RIDGE AVE APT 317
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City | PHILADELPHIA
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State | PA
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Zip | 19128-2268
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Country | US
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Telephone | 717-991-9396
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT007973
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License Number State | PA
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