Provider Demographics
NPI:1699896373
Name:TRETTER PHYSICAL THERAPY,PC
Entity type:Organization
Organization Name:TRETTER PHYSICAL THERAPY,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TRETTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-683-5555
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-0225
Mailing Address - Country:US
Mailing Address - Phone:812-683-5555
Mailing Address - Fax:812-683-1111
Practice Address - Street 1:307 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-1344
Practice Address - Country:US
Practice Address - Phone:812-683-5555
Practice Address - Fax:812-683-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002187A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200878490AMedicaid