Mark Anthony Retzlaff, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

001145 Issued in NY

Practice address

300 Grant Ave
Lake Katrine, NY 12449-5340

Phone

(845) 336-3500

NPI assigned

May 15, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652572800000",
    "number": "1841937505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 MONTGOMERY ST",
            "city": "COHOES",
            "state": "NY",
            "postal_code": "120473910",
            "telephone_number": "518-605-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 GRANT AVE",
            "city": "LAKE KATRINE",
            "state": "NY",
            "postal_code": "124495340",
            "telephone_number": "845-336-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETZLAFF",
        "first_name": "MARK",
        "middle_name": "ANTHONY",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-15",
        "last_updated": "2022-05-15",
        "certification_date": "2022-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "001145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Kristen Parkhurst, OTR/L
• Cynthia Pascaretti, FNP
• Alyson Peluso, PA-C
• Glen F. Pomerantz, OPTICIAN
• Gary I Povill, MD
• Karen A Rice, LPN
• Nicola Richards, FNP
• Lenore J Roach, LISW,LCSW
• Donald Z Rosenblum, M.D.
• Amy M Rosenthal, RN

• Physical Therapy Assistant in Lake Katrine, NY
• Providers in Lake Katrine, NY by specialty
• Physical Therapy Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.