MEDICARE: DOUG KRETZINGER ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1033248653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUG KRETZINGER ATC

Provider Business Mailing Address
First Line	:	265 BALMORAL WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-7915
Country	:	US
Telephone Number	:	719-226-1289
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 CRESTA RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-1622
Country	:	US
Telephone Number	:	719-338-0195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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