Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT00010225 | WA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT00010225 | WA |
NPI | 1174556534 |
---|---|
Provider Name | Conn E Wittwer |
First Address | Spokane Valley, WA 99016-9489 |
Second Address | Spokane Valley, WA 99016-9489 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 22/11/2016 |