Provider Demographics
NPI:1912541855
Name:RETHE, DEEPTI (PT)
Entity Type:Individual
Prefix:
First Name:DEEPTI
Middle Name:
Last Name:RETHE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 W HILLCREST DR APT 93
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2311
Mailing Address - Country:US
Mailing Address - Phone:859-539-4810
Mailing Address - Fax:
Practice Address - Street 1:1710 W HILLCREST DR APT 93
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-2311
Practice Address - Country:US
Practice Address - Phone:859-539-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist