Provider Demographics
NPI:1467448308
Name:WITTERSTAETTER, ANGELA KAY (PT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:KAY
Last Name:WITTERSTAETTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 CREEK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8398
Mailing Address - Country:US
Mailing Address - Phone:513-554-8080
Mailing Address - Fax:513-588-2479
Practice Address - Street 1:8737 UNION CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4878
Practice Address - Country:US
Practice Address - Phone:513-645-2246
Practice Address - Fax:513-645-2231
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.009970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2610900Medicaid
OHP00324335OtherMEDICARE RAILROAD
OH9400596OtherPHCS
OH000000328338OtherANTHEM
OH2610900Medicaid
OH0225920002Medicare NSC