Healthcare Provider Details

I. General information

NPI: 1003390733
Provider Name (Legal Business Name): MARIE DITTMAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739A S NOVA RD
ORMOND BEACH FL
32174-7332
US

IV. Provider business mailing address

1429 N ATLANTIC AVE UNIT 433
DAYTONA BEACH FL
32118-3553
US

V. Phone/Fax

Practice location:
  • Phone: 386-671-2626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number42947
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: