Healthcare Provider Details

I. General information

NPI: 1235349457
Provider Name (Legal Business Name): ERIC SCOTT FRUGE P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 KILBOURNE CIR
CARENCRO LA
70520-5375
US

IV. Provider business mailing address

201 KILBOURNE CIR
CARENCRO LA
70520-5375
US

V. Phone/Fax

Practice location:
  • Phone: 337-896-0445
  • Fax: 337-896-8729
Mailing address:
  • Phone: 337-896-0445
  • Fax: 337-896-8729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01594
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: