Provider Demographics
NPI:1982690947
Name:RITENOUR, DIANE K (PT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:RITENOUR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:K
Other - Last Name:LOOMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:240 N BLUFF BLVD STE 101 CLINTON PHYSICAL THERAPY SVCS
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52733-0337
Mailing Address - Country:US
Mailing Address - Phone:563-519-0242
Mailing Address - Fax:563-241-4353
Practice Address - Street 1:915 13TH AVE N
Practice Address - Street 2:CLINTON PHYSICAL THERAPY
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5067
Practice Address - Country:US
Practice Address - Phone:563-243-7814
Practice Address - Fax:563-243-2441
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02683225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0220996Medicaid
IA49204Medicare ID - Type Unspecified
S83272Medicare UPIN