Provider Demographics
NPI:1821476631
Name:RITUALO, ANGEL
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:RITUALO
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 1:922 WINTON LN NW
Mailing Address - Street 2:C
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9488
Mailing Address - Country:US
Mailing Address - Phone:360-620-3885
Mailing Address - Fax:
Practice Address - Street 1:922 WINTON LN NW
Practice Address - Street 2:C
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9488
Practice Address - Country:US
Practice Address - Phone:360-620-3885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60465788225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist