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1174190540 NPI number — CHRISTOPHER DAVID RETTIG PT,DPT

NPI Number: 1174190540
Health Care Provider/Practitioner: CHRISTOPHER DAVID RETTIG PT,DPT

Information about “1174190540” NPI (CHRISTOPHER DAVID RETTIG PT,DPT) exists in 1174190540 in HTML format HTML  |  1174190540 in plain Text format TXT  |  1174190540 in PDF (Portable Document Format) PDF  |  1174190540 in an XML format XML  formats.

NPI Number : 1174190540 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174190540",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RETTIG",
    "FirstName": "CHRISTOPHER",
    "MiddleName": "DAVID",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PT,DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "RETTIG",
    "OtherFirstName": "CHRIS",
    "OtherMiddleName": "DAVID",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PT,DPT",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "5 TAMARACK LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SCHENECTADY",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "12309-1803",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "518-727-4565",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3757 CARMAN RD STE 201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SCHENECTADY",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "12303-5442",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "518-356-3139",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/05/2021",
    "LastUpdateDate": "06/05/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "046196",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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