Healthcare Provider Details

I. General information

NPI: 1447650072
Provider Name (Legal Business Name): BRITTANI JEAN-MARIE RITTER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8227 NORTHWEST BLVD SUITE 160
INDIANAPOLIS IN
46278-1387
US

IV. Provider business mailing address

13034 AUGUSTUS CIR APT 203
FISHERS IN
46037-7729
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-5795
  • Fax:
Mailing address:
  • Phone: 513-967-2387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36002300A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: