Provider Demographics
NPI:1841960184
Name:KETTENRING, CHARLES (DPT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:KETTENRING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6564 LOS PUEBLOS PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4451
Mailing Address - Country:US
Mailing Address - Phone:801-671-4600
Mailing Address - Fax:
Practice Address - Street 1:5130 SAN FRANCISCO RD NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4618
Practice Address - Country:US
Practice Address - Phone:505-823-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist