Provider Demographics
NPI:1407414964
Name:WITZ, AARON JACOB (LMT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:JACOB
Last Name:WITZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 CARROLL SQ APT 6
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-1546
Mailing Address - Country:US
Mailing Address - Phone:847-922-8028
Mailing Address - Fax:
Practice Address - Street 1:453 DUNHAM RD STE 200
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1451
Practice Address - Country:US
Practice Address - Phone:314-315-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22714676225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist