Healthcare Provider Details

I. General information

NPI: 1023152485
Provider Name (Legal Business Name): AARON MICHAEL FRIED ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W OLIVE AVE
GLENDALE AZ
85302-3006
US

IV. Provider business mailing address

4473 E OXFORD LN
HIGLEY AZ
85236-5822
US

V. Phone/Fax

Practice location:
  • Phone: 623-845-3711
  • Fax:
Mailing address:
  • Phone: 480-292-9586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: