MEDICARE: BRENDA M FRITZ MPT

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	174400000X	Specialist	PT-1468	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010026646	OTHER	ID	BLUE SHIELD OF IDAHO ID#
2	T-383-7	OTHER	ID	BLUE CROSS OF IDAHO ID#
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	82-0510764	OTHER	ID	TAX ID#

General Provider Information

NPI Number	:	1093860710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA M FRITZ MPT

Provider Business Mailing Address
First Line	:	2570 CHANNING WAY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7515
Country	:	US
Telephone Number	:	208-529-8005
Fax Number	:	208-529-0251

Provider Business Practice Location Address
First Line	:	2570 CHANNING WAY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7515
Country	:	US
Telephone Number	:	208-529-8005
Fax Number	:	208-529-0251

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/04/2010

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Directions to “ BRENDA M FRITZ MPT” Practice Location

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