MEDICARE: DR. PATRICIA ROSE WITTE PT, DPT

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
1	225100000X	Physical Therapist	070027419	IL

General Provider Information

NPI Number	:	1215610407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA ROSE WITTE PT, DPT

Provider Business Mailing Address
First Line	:	5248 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5248 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2102
Country	:	US
Telephone Number	:	708-689-9737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	08/14/2023

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