Provider Demographics
NPI:1407908585
Name:TRITTSCHUH, JOHN C (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:TRITTSCHUH
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 1:890 NORTH BOUNDARY AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DELANO
Mailing Address - State:FL
Mailing Address - Zip Code:32720
Mailing Address - Country:US
Mailing Address - Phone:386-738-3456
Mailing Address - Fax:386-738-3466
Practice Address - Street 1:890 NORTH BOUNDARY AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:DELANO
Practice Address - State:FL
Practice Address - Zip Code:32720
Practice Address - Country:US
Practice Address - Phone:386-738-3456
Practice Address - Fax:386-738-3466
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY1743OtherBLUE CROSS
FLY1743OtherBLUE CROSS