Healthcare Provider Details

I. General information

NPI: 1144731373
Provider Name (Legal Business Name): KIMBERLY ANN FRICKE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2964 N STATE ROAD 7 STE 206
MARGATE FL
33063-5718
US

IV. Provider business mailing address

2964 N STATE ROAD 7 STE 206
MARGATE FL
33063-5718
US

V. Phone/Fax

Practice location:
  • Phone: 954-580-4080
  • Fax:
Mailing address:
  • Phone: 954-580-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number27878
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: