Provider Demographics
NPI:1467002568
Name:RENTSCHLER, GRACE ELLEN (PTA)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ELLEN
Last Name:RENTSCHLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 W ROAD 1 N
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-5846
Mailing Address - Country:US
Mailing Address - Phone:928-830-3821
Mailing Address - Fax:
Practice Address - Street 1:411 W ROAD 1 N
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5943
Practice Address - Country:US
Practice Address - Phone:928-636-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-014017225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant