Provider Demographics
NPI:1508869967
Name:WITTMEYER, BRYAN (MSPT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:WITTMEYER
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7060 SENECA ST
Mailing Address - Street 2:PLANT 23
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059
Mailing Address - Country:US
Mailing Address - Phone:716-687-4025
Mailing Address - Fax:716-687-7645
Practice Address - Street 1:7060 SENECA ST
Practice Address - Street 2:PLANT 23
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059
Practice Address - Country:US
Practice Address - Phone:716-687-4025
Practice Address - Fax:716-687-7645
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0246081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA4371Medicare ID - Type Unspecified