Provider Demographics
NPI:1285954362
Name:RETZER, JACQUELINE (DPT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:RETZER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:POGGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1260 B ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2955
Mailing Address - Country:US
Mailing Address - Phone:510-247-9971
Mailing Address - Fax:510-247-9974
Practice Address - Street 1:1260 B ST
Practice Address - Street 2:SUITE 250
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2955
Practice Address - Country:US
Practice Address - Phone:510-247-9971
Practice Address - Fax:510-247-9974
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist