Provider Demographics
NPI:1326440363
Name:WITT, KELLY (CMT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WITT
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 1ST ST SW
Mailing Address - Street 2:SUITE2
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4430
Mailing Address - Country:US
Mailing Address - Phone:540-985-0500
Mailing Address - Fax:540-985-0529
Practice Address - Street 1:1015 1ST ST SW
Practice Address - Street 2:SUITE2
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4430
Practice Address - Country:US
Practice Address - Phone:540-985-0500
Practice Address - Fax:540-985-0529
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist