Provider Demographics
NPI:1447534102
Name:RITCHEY, KELLIE RENEE (PTA)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:RENEE
Last Name:RITCHEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:KELLIE
Other - Middle Name:RENEE
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:11049 FARRAND RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:MI
Mailing Address - Zip Code:48457-9768
Mailing Address - Country:US
Mailing Address - Phone:810-496-1014
Mailing Address - Fax:
Practice Address - Street 1:5211 MARSH RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1106
Practice Address - Country:US
Practice Address - Phone:517-319-1400
Practice Address - Fax:517-318-0258
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002943225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant