Provider Demographics
NPI:1013179803
Name:VITTONE, WILLIAM M (PTA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:M
Last Name:VITTONE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 ALABASTER DR APT G-6
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-2595
Mailing Address - Country:US
Mailing Address - Phone:865-230-2817
Mailing Address - Fax:715-682-6662
Practice Address - Street 1:911 3RD ST W
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1311
Practice Address - Country:US
Practice Address - Phone:715-682-8172
Practice Address - Fax:715-682-6662
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2022-02-11
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-02-11
Provider Licenses
StateLicense IDTaxonomies
WI2007-19225200000X
TNPTA0000003525225200000X
MI5502006380225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant