Healthcare Provider Details

I. General information

NPI: 1588785430
Provider Name (Legal Business Name): YOUTH SPORTS TREATMENT & FITNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 ARION PARKWAY ST. 122
SAN ANTONIO TX
78216-2880
US

IV. Provider business mailing address

1218 ARION PARKWAY ST. 122
SAN ANTONIO TX
78216-2880
US

V. Phone/Fax

Practice location:
  • Phone: 210-404-0090
  • Fax: 210-447-9547
Mailing address:
  • Phone: 210-404-0090
  • Fax: 210-447-9547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAYTON D RETTIG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 210-404-0090