Provider Demographics
NPI:1174028237
Name:WITTENBACH, CARISSA NOELLE (DPT, ATC)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:NOELLE
Last Name:WITTENBACH
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 EARLEY ST
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-9207
Mailing Address - Country:US
Mailing Address - Phone:571-239-3610
Mailing Address - Fax:
Practice Address - Street 1:4700 LEBANON RD STE D2
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-8265
Practice Address - Country:US
Practice Address - Phone:704-366-7723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21321225100000X
NCLAT-46682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer