Healthcare Provider Details

I. General information

NPI: 1528145331
Provider Name (Legal Business Name): MR. JAMES MICHAEL RETTLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N US HIGHWAY 89
PRESCOTT AZ
86313-5001
US

IV. Provider business mailing address

1955 W ROCK CASTLE DR
PRESCOTT AZ
86305-2110
US

V. Phone/Fax

Practice location:
  • Phone: 928-455-4860
  • Fax: 928-776-6172
Mailing address:
  • Phone: 928-830-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: