Individual
MRS. JEANETTE MARIE DE WITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, ATC
Contact information
Practice address
6233 BANKERS RD STE 12, MOUNT PLEASANT, WI 53403-9700
(262) 358-6730
(866) 245-8064
Mailing address
6233 BANKERS RD STE 12, MOUNT PLEASANT, WI 53403-9700
(262) 358-6730
(866) 245-8064
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
008334
OH
225100000X
Physical Therapist
Primary
11903-24
WI
2255A2300X
Athletic Trainer
001071
OH
2255A2300X
Athletic Trainer
1315-39
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528087442
—
WI
01
—
859400073
MEDICARE
WI
Enumeration date
07/19/2006
Last updated
03/01/2017
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