Healthcare Provider Details

I. General information

NPI: 1407848088
Provider Name (Legal Business Name): FRED EDWARD TREECE PT MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 04/12/2006

III. Provider practice location address

1345 E MCKELLIPS RD 101
MESA AZ
85203-2721
US

IV. Provider business mailing address

745 N GILBERT RD STE 124 PMB 367
GILBERT AZ
85234-4616
US

V. Phone/Fax

Practice location:
  • Phone: 480-827-0495
  • Fax: 480-827-2354
Mailing address:
  • Phone: 480-821-4200
  • Fax: 480-821-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1600
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: