Provider Demographics
NPI:1619242732
Name:RIUTTA, AMELIA ANN
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:ANN
Last Name:RIUTTA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:AMELIA
Other - Middle Name:ANN
Other - Last Name:BRENDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3555 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-2503
Mailing Address - Country:US
Mailing Address - Phone:262-515-7066
Mailing Address - Fax:
Practice Address - Street 1:3555 10TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-2503
Practice Address - Country:US
Practice Address - Phone:262-515-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1269-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant