Provider Demographics
NPI:1942560396
Name:WITTWER, ARA (MS, ATC)
Entity Type:Individual
Prefix:
First Name:ARA
Middle Name:
Last Name:WITTWER
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 W OCEAN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-1413
Mailing Address - Country:US
Mailing Address - Phone:715-558-3994
Mailing Address - Fax:
Practice Address - Street 1:51 ODD RD
Practice Address - Street 2:
Practice Address - City:POQUOSON
Practice Address - State:VA
Practice Address - Zip Code:23662-2050
Practice Address - Country:US
Practice Address - Phone:757-868-7123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-19
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT . 0035102255A2300X
VA01260019162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer