Provider Demographics
NPI:1083722672
Name:DEWITT, CHANTAL (PT,LLCC,WCC)
Entity Type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:
Last Name:DEWITT
Suffix:
Gender:F
Credentials:PT,LLCC,WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 SW 76 TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4445
Mailing Address - Country:US
Mailing Address - Phone:305-666-7529
Mailing Address - Fax:
Practice Address - Street 1:6860 SW 76 TH TERRACE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4445
Practice Address - Country:US
Practice Address - Phone:305-666-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 6122225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY3872AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER