Provider Demographics
NPI:1871795294
Name:DITH, TITONATH (DPT)
Entity type:Individual
Prefix:DR
First Name:TITONATH
Middle Name:
Last Name:DITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13410 HIGHWAY 99
Mailing Address - Street 2:SUITE 204
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5454
Mailing Address - Country:US
Mailing Address - Phone:425-742-7300
Mailing Address - Fax:425-742-7334
Practice Address - Street 1:13410 HIGHWAY 99
Practice Address - Street 2:SUITE 204
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-5454
Practice Address - Country:US
Practice Address - Phone:425-742-7300
Practice Address - Fax:425-742-7334
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT00008126Medicaid
WAPT00008126Medicare ID - Type UnspecifiedPHYSICAL THERAPIST
WAPT00008126Medicaid