MEDICARE: ROBERTA MAE DITTMER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	0019005916	VA

General Provider Information

NPI Number	:	1902755572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA MAE DITTMER

Provider Business Mailing Address
First Line	:	411 N. YORK ROAD
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20164
Country	:	US
Telephone Number	:	703-200-8092
Fax Number	:

Provider Business Practice Location Address
First Line	:	8347-A GREENSBORO DRIVE
Second Line	:
City	:	MCLEAN
State	:	VA
Zip	:	22102
Country	:	US
Telephone Number	:	571-888-5193
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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