Provider Demographics
NPI:1609267087
Name:BITTERMAN, MICHEAL D (MA)
Entity Type:Individual
Prefix:
First Name:MICHEAL
Middle Name:D
Last Name:BITTERMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 GRANT RD
Mailing Address - Street 2:SUITE B27
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-5383
Mailing Address - Country:US
Mailing Address - Phone:509-884-1437
Mailing Address - Fax:509-884-2811
Practice Address - Street 1:230 GRANT RD
Practice Address - Street 2:SUITE B27
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5383
Practice Address - Country:US
Practice Address - Phone:509-884-1437
Practice Address - Fax:509-884-2811
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60530751225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist