Healthcare Provider Details

I. General information

NPI: 1700794641
Provider Name (Legal Business Name): PIERA LINDA ANN FRIES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 E GREENWAY RD STE 1
PHOENIX AZ
85032-4798
US

IV. Provider business mailing address

4502 N 36TH ST APT 315
PHOENIX AZ
85018-3403
US

V. Phone/Fax

Practice location:
  • Phone: 480-719-1644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-015196
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: