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NPI Code Detail

MEDICARE: LONNIE DITTRICK

MEDICARE: LONNIE DITTRICK
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
1225100000XPhysical Therapist03842OH

General Provider Information

NPI Number : 1700411022
Entity Type Code : Individual
Provider Name (Legal Business Name) : LONNIE DITTRICK
Provider Business Mailing Address
First Line : 7390 OLD OAK BLVD
Second Line :
City : MIDDLEBURG HEIGHTS
State : OH
Zip : 44130-3328
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7390 OLD OAK BLVD
Second Line :
City : MIDDLEBURG HEIGHTS
State : OH
Zip : 44130-3328
Country : US
Telephone Number : 440-816-8010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2020
Last Update Date : 03/06/2020

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Directions to “ LONNIE DITTRICK ” Practice Location

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