MEDICARE: MRS. NICOLE LEIGH FRY P.T.

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	PT 010001	OH

General Provider Information

NPI Number	:	1407828122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE LEIGH FRY P.T.

Provider Business Mailing Address
First Line	:	2843 OBSERVATORY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2332
Country	:	US
Telephone Number	:	513-289-6848
Fax Number	:

Provider Business Practice Location Address
First Line	:	9363 ALLEN RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3846
Country	:	US
Telephone Number	:	513-870-0039
Fax Number	:	513-870-0452

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/08/2007

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