Provider Demographics
NPI:1982844924
Name:RETTELE, JESSE J (L/CPO)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:J
Last Name:RETTELE
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Gender:M
Credentials:L/CPO
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Mailing Address - Street 1:7703 FLOYD CURL DR.
Mailing Address - Street 2:UTHSCSA REHABILITATION MEDICINE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-7799
Mailing Address - Country:US
Mailing Address - Phone:210-567-5346
Mailing Address - Fax:210-567-5302
Practice Address - Street 1:7703 FLOYD CURL DR.
Practice Address - Street 2:UTHSCSA REHABILITATION MEDICINE
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-7799
Practice Address - Country:US
Practice Address - Phone:210-567-5346
Practice Address - Fax:210-567-5302
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1492224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist