Provider Demographics
NPI:1447230214
Name:DEWITT, BRET EUGENE (PT)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:EUGENE
Last Name:DEWITT
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 1:1530 3RD ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-1562
Mailing Address - Country:US
Mailing Address - Phone:916-434-9572
Mailing Address - Fax:916-434-9063
Practice Address - Street 1:1530 3RD ST
Practice Address - Street 2:SUITE 211
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-1562
Practice Address - Country:US
Practice Address - Phone:916-434-9572
Practice Address - Fax:916-434-9063
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 140052251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic