Provider Demographics
NPI:1881883791
Name:LONTOC, RICARTHUR DANO (PT)
Entity type:Individual
Prefix:MR
First Name:RICARTHUR
Middle Name:DANO
Last Name:LONTOC
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:PO BOX 8704
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49023-8704
Mailing Address - Country:US
Mailing Address - Phone:269-925-9491
Mailing Address - Fax:269-925-9553
Practice Address - Street 1:1850 PIPESTONE RD
Practice Address - Street 2:STE. 202A
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-2304
Practice Address - Country:US
Practice Address - Phone:269-925-9491
Practice Address - Fax:269-925-9553
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI39028OtherHEALTH PLAN OF MICHIGAN
MI39028OtherHEALTH PLAN OF MICHIGAN