Provider Demographics
NPI:1003813544
Name:WITT, DEVIN WADE (PT)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:WADE
Last Name:WITT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 E WESTERN RESERVE RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3359
Mailing Address - Country:US
Mailing Address - Phone:330-758-8223
Mailing Address - Fax:
Practice Address - Street 1:822 E WESTERN RESERVE RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3359
Practice Address - Country:US
Practice Address - Phone:330-758-8223
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT08389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2310592Medicaid
OH4067103Medicare ID - Type Unspecified