Individual
DOUGLAS GENE WITTICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
8911 CLEMENT AVE FL 2, PARKVILLE, MD 21234-2603
(410) 256-0257
Mailing address
3607 KLAUSMIER RD, NOTTINGHAM, MD 21236-4818
(443) 794-0735
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
M02939
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M02939
MD DEPT OF HEALTH
MD
Enumeration date
01/09/2021
Last updated
01/09/2021
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