Healthcare Provider Details

I. General information

NPI: 1598266793
Provider Name (Legal Business Name): GALICIA FRYZLEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HILLS BEACH ROAD
BIDDEFORD ME
04005
US

IV. Provider business mailing address

11 HILLS BEACH RD
BIDDEFORD ME
04005-9526
US

V. Phone/Fax

Practice location:
  • Phone: 814-788-0277
  • Fax:
Mailing address:
  • Phone: 814-788-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2081S0010X
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: