Provider Demographics
NPI:1992749642
Name:WITT, DAVID JAY (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAY
Last Name:WITT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9216 PICOT CT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2464
Mailing Address - Country:US
Mailing Address - Phone:561-736-7371
Mailing Address - Fax:
Practice Address - Street 1:5162 LINTON BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6567
Practice Address - Country:US
Practice Address - Phone:561-637-4539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL005732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY918DOtherBCBS OFFICE PROVIDER #
FLY4700ZMedicare ID - Type UnspecifiedPT PROVIDER NUMBER
FLY918DOtherBCBS OFFICE PROVIDER #