Individual provider Active NPI

Eric O Witte, PT, DPT

  • Physical Therapist
  • Lisle, IL
National Provider Identifier
1336475490
Registry record updated Oct 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070017485 Issued in IL
Practice address
1026 Maple Ave
Lisle, IL 60532-2329
Phone
(630) 434-0271
Fax
(630) 434-0938
NPI assigned
Oct 26, 2009
Last updated
Oct 26, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070017485 IL Primary

Addresses

Primary practice location

1026 Maple Ave
Lisle, IL 60532-2329

Mailing address

6040 Route 53
Suite a
Lisle, IL 60532-3392
Phone (630) 434-0271

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070017485ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Orthopedics & Sports Medicine LLC Current Accepting new patients
Genesis Orthopedics & Sports Medicine LLC Current Accepting new patients
DPT Holdings, LLC Physical Therapist PastSince Jun 1, 2012 Accepting new patients
Progessive Physical Therapy, LLC Physical Therapist Past Accepting new patients
A Kraai LTD Physical Therapist Past Accepting new patients

Locations

2900 Foxfield Rd
Ste 102
St Charles, IL 60174
Phone (630) 209-1960

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256515200000",
    "number": "1336475490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6040 ROUTE 53",
            "address_2": "SUITE A",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323392",
            "telephone_number": "630-434-0271",
            "fax_number": "630-515-1536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1026 MAPLE AVE",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605322329",
            "telephone_number": "630-434-0271",
            "fax_number": "630-434-0938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTE",
        "first_name": "ERIC",
        "middle_name": "O",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-26",
        "last_updated": "2009-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070017485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lisle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.