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General NPI Number Information
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NPI Number | 1750328605
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Entity Type | Organization
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Legal Business Name | TRACY BRETL, D.O., S.C.
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 250 W COVENTRY CT
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City | GLENDALE
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State | WI
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Zip | 53217-3972
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Country | US
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Telephone | 414-351-8444
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Fax | 414-351-0678
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Provider Business Mailing Address
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Address Line | 250 W COVENTRY CT
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City | GLENDALE
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State | WI
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Zip | 53217-3966
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Country | US
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Telephone | 414-351-8444
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Fax | 414-351-0678
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TRACY LYNN BRETL
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Credential | D.O.
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Telephone | 414-351-1844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 31707
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License Number State | WI
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