Provider Demographics
NPI:1770948275
Name:KRETSCHMAR, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:KRETSCHMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E ROWAN AVE
Mailing Address - Street 2:STE. 202
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1214
Mailing Address - Country:US
Mailing Address - Phone:509-487-6222
Mailing Address - Fax:509-487-6333
Practice Address - Street 1:124 E ROWAN AVE
Practice Address - Street 2:STE. 202
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1214
Practice Address - Country:US
Practice Address - Phone:509-487-6222
Practice Address - Fax:509-487-6333
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60623295225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist