Provider Demographics
NPI:1821150624
Name:SCHRETENTHALER, KATHLEEN JOANN (PT CSCS)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:JOANN
Last Name:SCHRETENTHALER
Suffix:
Gender:F
Credentials:PT CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 W PARK STREET
Mailing Address - Street 2:SUITE #7
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047
Mailing Address - Country:US
Mailing Address - Phone:406-222-5519
Mailing Address - Fax:406-222-0366
Practice Address - Street 1:1313 W PARK STREET
Practice Address - Street 2:SUITE #7
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047
Practice Address - Country:US
Practice Address - Phone:406-222-5519
Practice Address - Fax:406-222-0366
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1105225100000X
WYPT-641225100000X
AZ3463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMSF1121482OtherMT STATE FUND
MT344556Medicaid
MT60146OtherBLUE CROSS BLUE SHIELD