Provider Demographics
NPI:1326309709
Name:KRETSCHMAR, JACOB (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:KRETSCHMAR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-0429
Mailing Address - Country:US
Mailing Address - Phone:701-550-9142
Mailing Address - Fax:
Practice Address - Street 1:13274 53RD ST NE
Practice Address - Street 2:
Practice Address - City:SPICER
Practice Address - State:MN
Practice Address - Zip Code:56288-9437
Practice Address - Country:US
Practice Address - Phone:701-550-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-02
Last Update Date:2012-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8219083-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic