Provider Demographics
NPI:1093162026
Name:WITOWIC, VIKTORIA (DPT)
Entity type:Individual
Prefix:
First Name:VIKTORIA
Middle Name:
Last Name:WITOWIC
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:855-456-7146
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:1302 PROSPECT AVE STE C
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3928
Practice Address - Country:US
Practice Address - Phone:406-502-1900
Practice Address - Fax:406-502-1333
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1919OtherSTATE PT LICENSE
MT11058OtherMT PT LICENSE