MEDICARE: GERARDO FRIAS

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 28882	FL

General Provider Information

NPI Number	:	1689099970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARDO FRIAS

Provider Business Mailing Address
First Line	:	9953 WOODRIDGE CT
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-4264
Country	:	US
Telephone Number	:	541-215-3447
Fax Number	:

Provider Business Practice Location Address
First Line	:	9953 WOODRIDGE CT
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-4264
Country	:	US
Telephone Number	:	541-215-3447
Fax Number	:

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

Provider Enumeration Date	:	02/24/2014
Last Update Date	:	02/24/2014

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Directions to “ GERARDO FRIAS ” Practice Location

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