MEDICARE: MR. DAVID JAY WITT P.T.

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	005732	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y918D	OTHER	FL	BCBS OFFICE PROVIDER #

General Provider Information

NPI Number	:	1992749642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID JAY WITT P.T.

Provider Business Mailing Address
First Line	:	9216 PICOT CT
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-2464
Country	:	US
Telephone Number	:	561-736-7371
Fax Number	:

Provider Business Practice Location Address
First Line	:	5162 LINTON BLVD
Second Line	:	SUITE 105
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6567
Country	:	US
Telephone Number	:	561-637-4539
Fax Number	:

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	08/24/2010

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