MEDICARE: ELIZABETH FRIERSON

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	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT22354	OTHER	FL	LICENSE #

General Provider Information

NPI Number	:	1285742551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH FRIERSON

Provider Business Mailing Address
First Line	:	807 PIPPIN DR
Second Line	:
City	:	NICEVILLE
State	:	FL
Zip	:	32578-4704
Country	:	US
Telephone Number	:	850-217-2340
Fax Number	:

Provider Business Practice Location Address
First Line	:	1008 AIRPORT RD STE A
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2822
Country	:	US
Telephone Number	:	850-837-3349
Fax Number	:

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

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	05/17/2011

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