Healthcare Provider Details

I. General information

NPI: 1942416466
Provider Name (Legal Business Name): PATRICIA W FRIEL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14247 VICTOR DR.
SEWARD AK
99664-2241
US

IV. Provider business mailing address

14247 VICTOR DR. PO BOX 2241
SEWARD AK
99664-2241
US

V. Phone/Fax

Practice location:
  • Phone: 907-224-5134
  • Fax: 907-224-5134
Mailing address:
  • Phone: 907-224-5134
  • Fax: 907-224-5134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1039
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: