Provider Demographics
NPI:1063757946
Name:WITTE-NIEMEYER, MARY C (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:WITTE-NIEMEYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:WITTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14575 ELBERT RD
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-9517
Mailing Address - Country:US
Mailing Address - Phone:719-332-7781
Mailing Address - Fax:
Practice Address - Street 1:7362 MCLAUGHLIN RD
Practice Address - Street 2:
Practice Address - City:FALCON
Practice Address - State:CO
Practice Address - Zip Code:80831-4713
Practice Address - Country:US
Practice Address - Phone:719-358-3866
Practice Address - Fax:719-559-1800
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6280OtherMEDICARE