Provider Demographics
NPI:1548360472
Name:ITTENBACH, DENNIS RICHARD (PT, MS)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:RICHARD
Last Name:ITTENBACH
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:60 MAIN ST UNIT G
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-6603
Mailing Address - Country:US
Mailing Address - Phone:843-715-4146
Mailing Address - Fax:843-715-4673
Practice Address - Street 1:60 MAIN ST UNIT G
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-6603
Practice Address - Country:US
Practice Address - Phone:843-342-5700
Practice Address - Fax:843-342-5702
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist