Provider Demographics
NPI:1477572055
Name:RETHABER, JAMES DANIEL
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DANIEL
Last Name:RETHABER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:DANIEL
Other - Last Name:RETHABER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAT, ATC, CSCS
Mailing Address - Street 1:4676 COUNTY ROAD 404
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-3369
Mailing Address - Country:US
Mailing Address - Phone:830-393-9717
Mailing Address - Fax:
Practice Address - Street 1:2829 BABCOCK SUITE #700
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:830-391-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT24382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer