Healthcare Provider Details

I. General information

NPI: 1942427646
Provider Name (Legal Business Name): MATTHEW J FRYBERGER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 S MERCY RD STE 121
GILBERT AZ
85297
US

IV. Provider business mailing address

3200 E CAMELBACK RD STE 250
PHOENIX AZ
85018-2327
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-2263
  • Fax: 602-933-4256
Mailing address:
  • Phone: 602-933-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5367
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5367
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: