Provider Demographics
NPI:1134514284
Name:RATKIEWICH, ROSANNE (LMT, CMT)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:RATKIEWICH
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 ARDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1612
Mailing Address - Country:US
Mailing Address - Phone:510-761-1462
Mailing Address - Fax:
Practice Address - Street 1:3833 ARDLEY AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1612
Practice Address - Country:US
Practice Address - Phone:510-761-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-04
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1694225700000X
OR6839225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist