Healthcare Provider Details

I. General information

NPI: 1083731269
Provider Name (Legal Business Name): AMANDA PATRICIA FRIES ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 ROLAND AVE
BALTIMORE MD
21210-1928
US

IV. Provider business mailing address

803 ROUND TOP CT APT 3A
LUTHERVILLE TIMONIUM MD
21093-5022
US

V. Phone/Fax

Practice location:
  • Phone: 410-323-3800
  • Fax: 410-864-2828
Mailing address:
  • Phone: 410-808-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: