Provider Demographics
NPI:1750622544
Name:WITT, JOSEPH PICKETT (ATC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PICKETT
Last Name:WITT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1584 WESLEYAN DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-5512
Mailing Address - Country:US
Mailing Address - Phone:757-455-3417
Mailing Address - Fax:757-233-8753
Practice Address - Street 1:1584 WESLEYAN DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-5512
Practice Address - Country:US
Practice Address - Phone:757-455-3417
Practice Address - Fax:757-233-8753
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260002052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer