Provider Demographics
NPI:1417031352
Name:BOLLENBACHER, RITA ANN (LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:RITA
Middle Name:ANN
Last Name:BOLLENBACHER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 N WHEELING AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1630
Mailing Address - Country:US
Mailing Address - Phone:765-281-0408
Mailing Address - Fax:
Practice Address - Street 1:2072 W STATE ROAD 67
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-6900
Practice Address - Country:US
Practice Address - Phone:260-726-9806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000574A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer