Provider Demographics
NPI:1043262710
Name:WITWER, EMILY N KEEBLE (PT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:N KEEBLE
Last Name:WITWER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-4534
Mailing Address - Country:US
Mailing Address - Phone:480-380-2810
Mailing Address - Fax:480-380-2861
Practice Address - Street 1:2414 N TRENTON
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-2527
Practice Address - Country:US
Practice Address - Phone:480-380-2810
Practice Address - Fax:480-380-2861
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ108301Medicare ID - Type UnspecifiedMEDICARE #