Provider Demographics
NPI:1093082919
Name:RITCHIE, JENNIFER NOELLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NOELLE
Last Name:RITCHIE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 THORN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436-9749
Mailing Address - Country:US
Mailing Address - Phone:815-616-2542
Mailing Address - Fax:
Practice Address - Street 1:605 S EDWARD DR
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-6507
Practice Address - Country:US
Practice Address - Phone:630-863-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160-002415225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant