Provider Demographics
NPI:1134405517
Name:RITTER, JAKE ROBERT (ATC MED)
Entity type:Individual
Prefix:MR
First Name:JAKE
Middle Name:ROBERT
Last Name:RITTER
Suffix:
Gender:M
Credentials:ATC MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 N SANDERS ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-1046
Mailing Address - Country:US
Mailing Address - Phone:509-720-0242
Mailing Address - Fax:
Practice Address - Street 1:1730 N SANDERS ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-1046
Practice Address - Country:US
Practice Address - Phone:509-720-0242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-29
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0049042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer