Provider Demographics
NPI:1003462680
Name:WITKIN, ARIEL (PT)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:WITKIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:ARI
Other - Middle Name:
Other - Last Name:WITKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1515 NW 18TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2516
Mailing Address - Country:US
Mailing Address - Phone:503-228-1306
Mailing Address - Fax:503-228-1307
Practice Address - Street 1:1515 NW 18TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2516
Practice Address - Country:US
Practice Address - Phone:503-228-1306
Practice Address - Fax:503-228-1307
Is Sole Proprietor?:No
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist