Healthcare Provider Details

I. General information

NPI: 1902138035
Provider Name (Legal Business Name): SANDRA KAY FREY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34406 N 27TH DR BLDG 2
PHOENIX AZ
85085-6082
US

IV. Provider business mailing address

18645 N 5TH DR
PHOENIX AZ
85027-6627
US

V. Phone/Fax

Practice location:
  • Phone: 623-266-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT00111P
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: