Provider Demographics
NPI:1205652872
Name:DRENKARD, GRETCHEN (LMT)
Entity type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:
Last Name:DRENKARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1526
Mailing Address - Country:US
Mailing Address - Phone:610-937-2706
Mailing Address - Fax:
Practice Address - Street 1:222 GOVERNMENT AVE STE A
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1868
Practice Address - Country:US
Practice Address - Phone:610-937-2706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-28
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL83529225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist