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General NPI Number Information
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NPI Number | 1457947244
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Entity Type | Individual
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Provider Name | CHASSIDY ELIZABETH RETTELL PTA
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Gender | Female
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 157 HOME AVE
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City | DARLINGTON
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State | SC
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Zip | 29532-7625
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Country | US
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Telephone | 286-784-3393
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Fax |
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Provider Business Mailing Address
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Address Line | 840 CHAUCER DR
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City | FLORENCE
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State | SC
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Zip | 29505-3635
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Country | US
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Telephone | 843-758-3075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA.4542
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License Number State | SC
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