Provider Demographics
NPI:1598312662
Name:RITNER, ALYSSA DANIELLE (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:DANIELLE
Last Name:RITNER
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 OLD MEADOW RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4330
Mailing Address - Country:US
Mailing Address - Phone:703-783-3529
Mailing Address - Fax:
Practice Address - Street 1:1760 OLD MEADOW RD STE 220
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4330
Practice Address - Country:US
Practice Address - Phone:703-783-3529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0007254363A00000X
DCPA031620363A00000X
VA0110006772363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant