Healthcare Provider Details

I. General information

NPI: 1376533398
Provider Name (Legal Business Name): GREG FREY COF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ABRAHAM FLEXNER WAY SUITE 760
LOUISVILLE KY
40202-1846
US

IV. Provider business mailing address

225 ABRAHAM FLEXNER WAY SUITE 760
LOUISVILLE KY
40202-1846
US

V. Phone/Fax

Practice location:
  • Phone: 502-561-4263
  • Fax: 502-561-4221
Mailing address:
  • Phone: 502-561-4263
  • Fax: 502-561-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC15923
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC15923
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: