Provider Demographics
NPI:1639458532
Name:RAVETTINE, BRITTNEY D
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:D
Last Name:RAVETTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W 107TH ST
Mailing Address - Street 2:APT 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3128
Mailing Address - Country:US
Mailing Address - Phone:201-519-3274
Mailing Address - Fax:
Practice Address - Street 1:37 UNION SQ W
Practice Address - Street 2:FLOOR 3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3217
Practice Address - Country:US
Practice Address - Phone:212-750-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01413100225100000X
NY033945-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist