Provider Demographics
NPI:1861828816
Name:WITTMAN, BENJAMIN JOSEPH (DPT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JOSEPH
Last Name:WITTMAN
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 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:2946 WINFIELD DUNN PKWY STE 106
Practice Address - Street 2:
Practice Address - City:KODAK
Practice Address - State:TN
Practice Address - Zip Code:37764
Practice Address - Country:US
Practice Address - Phone:865-932-1088
Practice Address - Fax:865-932-1454
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist