Provider Demographics
NPI:1407293368
Name:RITT, LEIA CHRISTINE (ATC)
Entity Type:Individual
Prefix:
First Name:LEIA
Middle Name:CHRISTINE
Last Name:RITT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:LEIA
Other - Middle Name:CHRISTINE
Other - Last Name:VAN BOOVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1508 DIXON DR
Mailing Address - Street 2:
Mailing Address - City:ST PAUL PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55071-1235
Mailing Address - Country:US
Mailing Address - Phone:651-470-1549
Mailing Address - Fax:
Practice Address - Street 1:8040 80TH ST S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-2052
Practice Address - Country:US
Practice Address - Phone:651-768-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer