Provider Demographics
NPI:1922232966
Name:WITTE, JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:WITTE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 CARLTON AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1609
Mailing Address - Country:US
Mailing Address - Phone:616-334-2615
Mailing Address - Fax:
Practice Address - Street 1:3355 EAGLE PARK DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7004
Practice Address - Country:US
Practice Address - Phone:616-334-2615
Practice Address - Fax:616-667-9552
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist