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Individual

MAUREEN DITTA

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
MPT

Contact information

Practice address
404 NE PENN AVE, BEND, OR 97701-4264
(541) 318-7041
Mailing address
21658 DALE RD, BEND, OR 97701-8819

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4929
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
213650
OR
Enumeration date
01/03/2006
Last updated
07/08/2007
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