Provider Demographics
NPI:1366232928
Name:WITTEMANN, MADELYNN C (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:MADELYNN
Middle Name:C
Last Name:WITTEMANN
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 W 700 S
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-1893
Mailing Address - Country:US
Mailing Address - Phone:480-494-7487
Mailing Address - Fax:
Practice Address - Street 1:2012 W 700 S
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-1893
Practice Address - Country:US
Practice Address - Phone:480-494-7487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14220405-4810204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine