Provider Demographics
NPI:1184861676
Name:RITZENTHALER, DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:RITZENTHALER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5717 OAKLAND DR
Mailing Address - Street 2:STE B
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1116
Mailing Address - Country:US
Mailing Address - Phone:269-488-2176
Mailing Address - Fax:269-343-9769
Practice Address - Street 1:5717 OAKLAND DR
Practice Address - Street 2:STE B
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1116
Practice Address - Country:US
Practice Address - Phone:269-488-8360
Practice Address - Fax:269-488-8359
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014270174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650C901910OtherBCBS
MI0N74060008Medicare PIN