Provider Demographics
NPI:1902298730
Name:WITTE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WITTE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-618-7587
Mailing Address - Street 1:804 SOUTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:NE
Mailing Address - Zip Code:68037-7058
Mailing Address - Country:US
Mailing Address - Phone:402-618-7587
Mailing Address - Fax:
Practice Address - Street 1:1268 E HENRY STREET. SUITE 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:NE
Practice Address - Zip Code:68048
Practice Address - Country:US
Practice Address - Phone:402-234-3333
Practice Address - Fax:844-272-6479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2866261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy