Provider Demographics
NPI:1083762413
Name:TRITTSCHUH PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:TRITTSCHUH PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:386-738-3456
Mailing Address - Street 1:890 N BOUNDARY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720
Mailing Address - Country:US
Mailing Address - Phone:386-738-3456
Mailing Address - Fax:386-738-3466
Practice Address - Street 1:890 N BOUNDARY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720
Practice Address - Country:US
Practice Address - Phone:386-738-3456
Practice Address - Fax:386-738-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
FLPTA18730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA0883OtherRR MEDICARE
K4359Medicare PIN