Provider Demographics
NPI:1508412107
Name:WITTER, ALEX (MS, ATC, LAT,)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:WITTER
Suffix:
Gender:M
Credentials:MS, ATC, LAT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 NW 11TH ST APT 18
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3163
Mailing Address - Country:US
Mailing Address - Phone:239-247-9945
Mailing Address - Fax:
Practice Address - Street 1:2421 NW 11TH ST APT 18
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3163
Practice Address - Country:US
Practice Address - Phone:239-247-9945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL45502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer