Individual
MIRANDA LEANNE RETTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
600 S MAPLE ST, PIPER CITY, IL 60959
(815) 686-2277
Mailing address
600 S MAPLE ST, PIPER CITY, IL 60959-7095
(815) 686-2277
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.006575
IL
Other
Enumeration date
07/03/2019
Last updated
07/03/2019
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