Provider Demographics
NPI:1174190540
Name:RETTIG, CHRISTOPHER DAVID (PT,DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:RETTIG
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:DAVID
Other - Last Name:RETTIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:5 TAMARACK LN
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1803
Mailing Address - Country:US
Mailing Address - Phone:518-727-4565
Mailing Address - Fax:
Practice Address - Street 1:3757 CARMAN RD STE 201
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-5442
Practice Address - Country:US
Practice Address - Phone:518-356-3139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-05
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist