Provider Demographics
NPI:1467896779
Name:KRETSCHMER, JAMIE (PT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:KRETSCHMER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33859 168TH ST
Mailing Address - Street 2:
Mailing Address - City:HONEY CREEK
Mailing Address - State:IA
Mailing Address - Zip Code:51542-4522
Mailing Address - Country:US
Mailing Address - Phone:712-642-2188
Mailing Address - Fax:
Practice Address - Street 1:7 ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0239
Practice Address - Country:US
Practice Address - Phone:712-328-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005137225100000X
NE1777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist