Provider Demographics
NPI:1336361765
Name:WITTORFF, CHRISTINE M (LAT, ATC, PTA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:M
Last Name:WITTORFF
Suffix:
Gender:F
Credentials:LAT, ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5555
Mailing Address - Country:US
Mailing Address - Phone:775-265-8389
Mailing Address - Fax:
Practice Address - Street 1:13 SCOTT ST
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5555
Practice Address - Country:US
Practice Address - Phone:775-265-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05060922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer