Provider Demographics
NPI:1376013995
Name:BRETZ, MEGAN K
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:K
Last Name:BRETZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14750-9627
Mailing Address - Country:US
Mailing Address - Phone:716-720-0199
Mailing Address - Fax:
Practice Address - Street 1:1 WHITTER WAY
Practice Address - Street 2:
Practice Address - City:GHENT
Practice Address - State:NY
Practice Address - Zip Code:12075-3213
Practice Address - Country:US
Practice Address - Phone:716-720-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant