Healthcare Provider Details

I. General information

NPI: 1992355093
Provider Name (Legal Business Name): FRYE SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N RONALD REAGAN BLVD STE 1060
LONGWOOD FL
32750-3530
US

IV. Provider business mailing address

300 LA CREEK CT
DEBARY FL
32713-4523
US

V. Phone/Fax

Practice location:
  • Phone: 386-290-7765
  • Fax:
Mailing address:
  • Phone: 386-290-7765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. GREG FRYE
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, DPT, SCS
Phone: 386-290-7765