Healthcare Provider Details

I. General information

NPI: 1528032463
Provider Name (Legal Business Name): MICHAEL W FREY MSED, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 NW RIVER PARK DR #1062
PARKVILLE MO
64152-4358
US

IV. Provider business mailing address

8700 NW RIVER PARK DR #1062
PARKVILLE MO
64152-4358
US

V. Phone/Fax

Practice location:
  • Phone: 816-584-6353
  • Fax: 816-505-5474
Mailing address:
  • Phone: 816-584-6353
  • Fax: 816-505-5474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2003022694
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: