Provider Demographics
NPI:1093050528
Name:WITTE, OLIVIA DEE (PT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:DEE
Last Name:WITTE
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 1:1615 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3338
Mailing Address - Country:US
Mailing Address - Phone:402-730-3446
Mailing Address - Fax:
Practice Address - Street 1:1615 WABASH AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3338
Practice Address - Country:US
Practice Address - Phone:402-730-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist