Provider Demographics
NPI:1225299951
Name:WITTMANN, GARY M (PT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:WITTMANN
Suffix:
Gender:M
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:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:DAUPHIN ISLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36528-0384
Mailing Address - Country:US
Mailing Address - Phone:251-861-3206
Mailing Address - Fax:251-380-3317
Practice Address - Street 1:1515 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2958
Practice Address - Country:US
Practice Address - Phone:251-343-9600
Practice Address - Fax:251-380-3328
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPTH473OtherPHYSICAL THERAPIST LICENSE