Provider Demographics
NPI:1043686736
Name:WITTERT, ALAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:WITTERT
Suffix:
Gender:M
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 1:6610 149TH ST
Mailing Address - Street 2:APT.4C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1353
Mailing Address - Country:US
Mailing Address - Phone:646-209-0515
Mailing Address - Fax:
Practice Address - Street 1:6610 149TH ST
Practice Address - Street 2:APT.4C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1353
Practice Address - Country:US
Practice Address - Phone:646-209-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039366-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist