Provider Demographics
NPI:1497864862
Name:WITAS, MICHALA R (PT)
Entity Type:Individual
Prefix:MS
First Name:MICHALA
Middle Name:R
Last Name:WITAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MICHALA
Other - Middle Name:R
Other - Last Name:KINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6404 NORTH 70TH PLAZA
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104
Mailing Address - Country:US
Mailing Address - Phone:402-573-3700
Mailing Address - Fax:402-573-3790
Practice Address - Street 1:2102 HARVELL CIRCLE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005
Practice Address - Country:US
Practice Address - Phone:402-293-5500
Practice Address - Fax:402-293-5505
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE278823Medicare PIN
Q42303Medicare UPIN