Provider Demographics
NPI:1184105793
Name:WITTENBERGER, MELANIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:WITTENBERGER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1110
Mailing Address - Country:US
Mailing Address - Phone:919-791-6678
Mailing Address - Fax:
Practice Address - Street 1:256 GRAND HILL PL
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-4483
Practice Address - Country:US
Practice Address - Phone:919-791-6678
Practice Address - Fax:856-228-2105
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist