Provider Demographics
NPI:1033248653
Name:KRETZINGER, DOUG (ATC)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:KRETZINGER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 BALMORAL WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7915
Mailing Address - Country:US
Mailing Address - Phone:719-226-1289
Mailing Address - Fax:
Practice Address - Street 1:1200 CRESTA RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-1622
Practice Address - Country:US
Practice Address - Phone:719-338-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22Medicare ID - Type Unspecified