Provider Demographics
NPI:1760557094
Name:REITSMA, BERT RYAN (PT)
Entity Type:Individual
Prefix:MR
First Name:BERT
Middle Name:RYAN
Last Name:REITSMA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HOWELL BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:PONCE DE LEON
Mailing Address - State:FL
Mailing Address - Zip Code:32455-4632
Mailing Address - Country:US
Mailing Address - Phone:941-228-9134
Mailing Address - Fax:
Practice Address - Street 1:32 HOWELL BLUFF RD
Practice Address - Street 2:
Practice Address - City:PONCE DE LEON
Practice Address - State:FL
Practice Address - Zip Code:32455-4632
Practice Address - Country:US
Practice Address - Phone:941-228-9134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2421225100000X
FLPT13831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2421OtherPT LICENSE