Basic Information
| Provider Information | |||||||||
| NPI: | 1326598012 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RITTEROVA | ||||||||
| FirstName: | MARIANNE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 324 GANNETT DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SOUTH PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041063266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074827861 | ||||||||
| FaxNumber: | 2079566676 | ||||||||
| Practice Location | |||||||||
| Address1: | 33 SEWALL ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041022603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174450647 | ||||||||
| FaxNumber: | 6174270403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2016 | ||||||||
| LastUpdateDate: | 05/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT5092 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.