Provider Demographics
NPI:1528394475
Name:RITTLER, MARY L (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:RITTLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:LAWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N84W17049 MENOMONEE AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2701
Mailing Address - Country:US
Mailing Address - Phone:262-255-1180
Mailing Address - Fax:262-255-2503
Practice Address - Street 1:N84W17049 MENOMONEE AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2701
Practice Address - Country:US
Practice Address - Phone:262-255-1180
Practice Address - Fax:262-255-2503
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11355-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIAPPLICATION PENDINGMedicaid