Provider Demographics
NPI:1477991016
Name:KRETCHEK, CHARLES BENJAMIN (DPT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BENJAMIN
Last Name:KRETCHEK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 BROOKTREE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9217
Mailing Address - Country:US
Mailing Address - Phone:877-827-8246
Mailing Address - Fax:877-827-8246
Practice Address - Street 1:7500 BROOKTREE RD STE 300
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9217
Practice Address - Country:US
Practice Address - Phone:877-827-8246
Practice Address - Fax:877-827-8246
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist