Provider Demographics
NPI:1013435312
Name:SITLER, MIKE RALPH (EDD, ATC, FNATA)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:RALPH
Last Name:SITLER
Suffix:
Gender:M
Credentials:EDD, ATC, FNATA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1857
Mailing Address - Country:US
Mailing Address - Phone:215-953-0848
Mailing Address - Fax:
Practice Address - Street 1:1800 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-3302
Practice Address - Country:US
Practice Address - Phone:215-204-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000632B2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer