Provider Demographics
NPI:1851939342
Name:RETTENMEIER, LIAM (LAT, ATC,EMT)
Entity Type:Individual
Prefix:
First Name:LIAM
Middle Name:
Last Name:RETTENMEIER
Suffix:
Gender:M
Credentials:LAT, ATC,EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 28TH ST APT 13
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-3130
Mailing Address - Country:US
Mailing Address - Phone:847-848-4475
Mailing Address - Fax:
Practice Address - Street 1:107 28TH ST APT 13
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-3130
Practice Address - Country:US
Practice Address - Phone:847-848-4475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-15
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer