Provider Demographics
NPI:1336475490
Name:WITTE, ERIC O (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:O
Last Name:WITTE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 ROUTE 53
Mailing Address - Street 2:SUITE A
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3392
Mailing Address - Country:US
Mailing Address - Phone:630-434-0271
Mailing Address - Fax:630-515-1536
Practice Address - Street 1:1026 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-2329
Practice Address - Country:US
Practice Address - Phone:630-434-0271
Practice Address - Fax:630-434-0938
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist