Provider Demographics
NPI:1497904817
Name:WURL, GRETCHEN LYN (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:LYN
Last Name:WURL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:GRETCHEN
Other - Middle Name:LYN
Other - Last Name:DEXHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5107 TUSCARORA RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1165
Mailing Address - Country:US
Mailing Address - Phone:716-957-4333
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-5040
Practice Address - Fax:716-898-3259
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029815-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist