Provider Demographics
NPI:1013648013
Name:VITAK, JANE EVERETT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:EVERETT
Last Name:VITAK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 WHIPPLE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-2418
Mailing Address - Country:US
Mailing Address - Phone:540-808-5898
Mailing Address - Fax:
Practice Address - Street 1:1995 S MAIN ST STE 801
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6637
Practice Address - Country:US
Practice Address - Phone:540-951-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist