Provider Demographics
NPI:1699798017
Name:WITAS, MARNY E (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MARNY
Middle Name:E
Last Name:WITAS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PLAZA DR.
Mailing Address - Street 2:UNIT 6
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-289-1010
Mailing Address - Fax:207-289-1011
Practice Address - Street 1:25 PLAZA DR.
Practice Address - Street 2:UNIT 6
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-289-1010
Practice Address - Fax:207-289-1011
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist