Provider Demographics
NPI:1821435272
Name:RETTON, CYNTHIA ELAINE (PT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELAINE
Last Name:RETTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:515 TAGGART DR NW
Practice Address - Street 2:SUITE 150
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4099
Practice Address - Country:US
Practice Address - Phone:503-363-6770
Practice Address - Fax:503-363-4789
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26702225100000X
OR61829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500712374Medicaid
ORR189362Medicare PIN