Provider Demographics
NPI:1528356672
Name:RAMAEKER, CHRISTEN BRIANNE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:BRIANNE
Last Name:RAMAEKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTEN
Other - Middle Name:BRIANNE
Other - Last Name:DOTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:1815 E IRELAND RD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-2845
Practice Address - Country:US
Practice Address - Phone:574-647-5790
Practice Address - Fax:574-647-5792
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012631A225100000X
IA077535225100000X
TX1200898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300005498Medicaid