Provider Demographics
NPI:1508903469
Name:TRETTER, THERESA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:TRETTER
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 1:307 N MAIN ST
Mailing Address - Street 2:P.O. BOX 225
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-1344
Mailing Address - Country:US
Mailing Address - Phone:812-683-5555
Mailing Address - Fax:812-683-1111
Practice Address - Street 1:307 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-1344
Practice Address - Country:US
Practice Address - Phone:812-683-5555
Practice Address - Fax:812-683-1111
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002187A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN249870AMedicare PIN