Provider Demographics
NPI:1326370503
Name:DITTFURTH, HEATH JUSTIN (PT)
Entity Type:Individual
Prefix:
First Name:HEATH
Middle Name:JUSTIN
Last Name:DITTFURTH
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 1:1100 N BLUE MOUND RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76131-4901
Mailing Address - Country:US
Mailing Address - Phone:817-232-3553
Mailing Address - Fax:817-232-7882
Practice Address - Street 1:1100 N BLUE MOUND RD
Practice Address - Street 2:SUITE 130
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131-4901
Practice Address - Country:US
Practice Address - Phone:817-232-3553
Practice Address - Fax:817-232-7882
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1191480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist