Provider Demographics
NPI:1790201853
Name:FRITSCHKA, TREVIN (DPT)
Entity Type:Individual
Prefix:MR
First Name:TREVIN
Middle Name:
Last Name:FRITSCHKA
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 1:7207 LOST LAKE RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR
Mailing Address - State:WI
Mailing Address - Zip Code:54209-9238
Mailing Address - Country:US
Mailing Address - Phone:920-737-8304
Mailing Address - Fax:
Practice Address - Street 1:209 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2828
Practice Address - Country:US
Practice Address - Phone:509-522-5710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-20
Last Update Date:2017-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60744971261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy