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NPI Code Detail

MEDICARE: MRS. STACY JEAN FRITZ PT, DPT

MEDICARE: MRS. STACY JEAN FRITZ PT, DPT
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
1225100000XPhysical Therapist2285NE
2225100000XPhysical Therapist03735IA
3225100000XPhysical Therapist8676CO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00443767OTHERNEMEDICARE RR

General Provider Information

NPI Number : 1851353619
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACY JEAN FRITZ PT, DPT
Provider Business Mailing Address
First Line : 3305 N 163RD PLZ
Second Line : APT 204
City : OMAHA
State : NE
Zip : 68116-2125
Country : US
Telephone Number : 402-968-0762
Fax Number : 402-493-6979
Provider Business Practice Location Address
First Line : 7818 DODGE ST
Second Line :
City : OMAHA
State : NE
Zip : 68114-3412
Country : US
Telephone Number : 402-493-6808
Fax Number : 402-493-6979
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2006
Last Update Date : 08/19/2008

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