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NPI Code Detail

MEDICARE: STEVEN G WITTROCK PT

MEDICARE: STEVEN G WITTROCK PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251X0800XOrthopedic Physical TherapistPT00002055WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115613OTHERWADEPT OF LABOR & INDUSTRIE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104823129
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN G WITTROCK PT
Provider Business Mailing Address
First Line : 27431 12TH PL S
Second Line :
City : DES MOINES
State : WA
Zip : 98198-9418
Country : US
Telephone Number : 253-838-2464
Fax Number : 253-838-4991
Provider Business Practice Location Address
First Line : 22659 PACIFIC HWY S
Second Line :
City : DES MOINES
State : WA
Zip : 98198-5155
Country : US
Telephone Number : 206-824-3668
Fax Number : 206-824-3964
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 07/09/2007

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