Provider Demographics
NPI:1336192111
Name:KRETUNSKI, DALE JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:JOSEPH
Last Name:KRETUNSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16224 E 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-1524
Mailing Address - Country:US
Mailing Address - Phone:586-773-9530
Mailing Address - Fax:586-773-7765
Practice Address - Street 1:16224 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-1524
Practice Address - Country:US
Practice Address - Phone:586-773-9530
Practice Address - Fax:586-773-7765
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M78240Medicare ID - Type Unspecified
MIT33119Medicare UPIN