Provider Demographics
NPI:1407873276
Name:GRETSKY, KEVIN L (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:L
Last Name:GRETSKY
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:181 INTREPID LN
Mailing Address - Street 2:BRIGHTON PHYSICAL THERAPY, PLLC
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2548
Mailing Address - Country:US
Mailing Address - Phone:315-558-4907
Mailing Address - Fax:
Practice Address - Street 1:181 INTREPID LN
Practice Address - Street 2:BRIGHTON PHYSICAL THERAPY, PLLC
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2548
Practice Address - Country:US
Practice Address - Phone:315-558-4907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist