Basic Information
| Provider Information | |||||||||
| NPI: | 1548522634 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WITTWER | ||||||||
| FirstName: | WELTON | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 790 | ||||||||
| Address2: | |||||||||
| City: | THERMOPOLIS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824430790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078642146 | ||||||||
| FaxNumber: | 3078642857 | ||||||||
| Practice Location | |||||||||
| Address1: | 148 E ARAPAHOE ST | ||||||||
| Address2: | |||||||||
| City: | THERMOPOLIS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824432402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078642146 | ||||||||
| FaxNumber: | 3078642857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2012 | ||||||||
| LastUpdateDate: | 06/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-1427 | WY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.