Provider Demographics
NPI:1447618426
Name:WITTER, MICHAEL DRISCOLL (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DRISCOLL
Last Name:WITTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1186 EVANGELINE DR
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-6420
Mailing Address - Country:US
Mailing Address - Phone:516-972-5335
Mailing Address - Fax:
Practice Address - Street 1:2024 OLDE REGENT WAY STE 130
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4250
Practice Address - Country:US
Practice Address - Phone:910-302-3330
Practice Address - Fax:910-765-7722
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21211225100000X
NY62 039916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist