Provider Demographics
NPI:1083327399
Name:RITTGERS, ZACHARY TYLER
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:TYLER
Last Name:RITTGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 S ELM PL STE C
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7949
Mailing Address - Country:US
Mailing Address - Phone:539-367-2737
Mailing Address - Fax:
Practice Address - Street 1:3104 S ELM PL STE C
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7949
Practice Address - Country:US
Practice Address - Phone:539-367-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator