Provider Demographics
NPI:1033399365
Name:WITTKAMPER, RODNEY L (PT)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:L
Last Name:WITTKAMPER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7060 E DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-8405
Mailing Address - Country:US
Mailing Address - Phone:765-552-7404
Mailing Address - Fax:
Practice Address - Street 1:7060 E DIVISION RD
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-8405
Practice Address - Country:US
Practice Address - Phone:765-552-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-03
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007027A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist