Provider Demographics
NPI:1386136216
Name:BORETZKY, STEPHEN E (PTA)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:E
Last Name:BORETZKY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 YORK RD STE C101
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6212
Mailing Address - Country:US
Mailing Address - Phone:410-321-0377
Mailing Address - Fax:410-821-7517
Practice Address - Street 1:1212 YORK RD STE C101
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6212
Practice Address - Country:US
Practice Address - Phone:410-321-0377
Practice Address - Fax:410-821-7517
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4938225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant