Provider Demographics
NPI:1467557934
Name:WITTMAYER, JUSTIN H (DPT)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:H
Last Name:WITTMAYER
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 1:2333 W 57TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5053
Mailing Address - Country:US
Mailing Address - Phone:605-361-1700
Mailing Address - Fax:605-361-0113
Practice Address - Street 1:2333 W 57TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5053
Practice Address - Country:US
Practice Address - Phone:605-361-1700
Practice Address - Fax:605-361-0113
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist