Provider Demographics
NPI:1033691324
Name:RITCHIE, KARLEY ANN
Entity Type:Individual
Prefix:
First Name:KARLEY
Middle Name:ANN
Last Name:RITCHIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CHRYSTAL LN
Mailing Address - Street 2:
Mailing Address - City:ORE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75683-9603
Mailing Address - Country:US
Mailing Address - Phone:903-720-7399
Mailing Address - Fax:
Practice Address - Street 1:1814 ROSELAND BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4262
Practice Address - Country:US
Practice Address - Phone:903-525-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-03
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2131418225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant