Provider Demographics
NPI:1164109302
Name:KITTERMAN, JOHN HARLAN IV (MS, ATC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HARLAN
Last Name:KITTERMAN
Suffix:IV
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 TOTEM DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-7959
Mailing Address - Country:US
Mailing Address - Phone:626-484-9759
Mailing Address - Fax:
Practice Address - Street 1:2675 PALO VERDE BLVD S
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-4919
Practice Address - Country:US
Practice Address - Phone:626-484-9759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer