Provider Demographics
NPI:1699894253
Name:WITKOWSKI, JAY M (PT,CSCS)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:M
Last Name:WITKOWSKI
Suffix:
Gender:M
Credentials:PT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-9618
Mailing Address - Country:US
Mailing Address - Phone:215-598-0876
Mailing Address - Fax:215-598-0344
Practice Address - Street 1:622 DURHAM RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-9618
Practice Address - Country:US
Practice Address - Phone:215-598-0876
Practice Address - Fax:215-598-0344
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006460L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWI739828OtherHIGHMARK BLUESHIELD NUMBE
PA959147S79Medicare ID - Type Unspecified