1184901118 NPI number — MISS MEAGAN ANN FREY DPT

Table of content: MISS MEAGAN ANN FREY DPT (NPI 1184901118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184901118 NPI number — MISS MEAGAN ANN FREY DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREY
Provider First Name:
MEAGAN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184901118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13830 58TH ST N
Provider Second Line Business Mailing Address:
SUITE 409
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33760-3720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-532-1900
Provider Business Mailing Address Fax Number:
727-532-4300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13830 58TH ST N
Provider Second Line Business Practice Location Address:
SUITE 409
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33760-3720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-532-1900
Provider Business Practice Location Address Fax Number:
727-532-4300
Provider Enumeration Date:
11/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  PT26538 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT26538 . This is a "DOCTOR OF PHYSICAL THERAPY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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