Provider Demographics
NPI:1912975665
Name:WITBECK, CRAIG R (MSPT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:R
Last Name:WITBECK
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S CHESTNUT ST
Mailing Address - Street 2:STE B
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677
Mailing Address - Country:US
Mailing Address - Phone:231-832-2005
Mailing Address - Fax:231-832-2508
Practice Address - Street 1:207 S CHESTNUT ST
Practice Address - Street 2:STE B
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677
Practice Address - Country:US
Practice Address - Phone:231-832-2005
Practice Address - Fax:231-832-2508
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F71015OtherBCBS OF MI
MI0N79170Medicare ID - Type Unspecified
MI0F71015OtherBCBS OF MI