Provider Demographics
NPI:1578920021
Name:KREICHER, JAMES BRYAN (PTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRYAN
Last Name:KREICHER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KENSINGTON BLVD
Mailing Address - Street 2:UNIT 1408
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7464
Mailing Address - Country:US
Mailing Address - Phone:440-258-3448
Mailing Address - Fax:
Practice Address - Street 1:100 KENSINGTON BLVD
Practice Address - Street 2:UNIT 1408
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7464
Practice Address - Country:US
Practice Address - Phone:440-258-3448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3032225200000X
TX2109985225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant