Provider Demographics
NPI:1265578884
Name:TALBOT, RETTIG W (PT)
Entity type:Individual
Prefix:MR
First Name:RETTIG
Middle Name:W
Last Name:TALBOT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7593 BOYNTON BEACH BLVD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6154
Mailing Address - Country:US
Mailing Address - Phone:561-733-5888
Mailing Address - Fax:888-714-5190
Practice Address - Street 1:7593 BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6154
Practice Address - Country:US
Practice Address - Phone:561-733-5888
Practice Address - Fax:888-714-5190
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 47462251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00450774OtherMEDICARE RAIL ROAD
FLAE293ZMedicare PIN