Healthcare Provider Details

I. General information

NPI: 1336367812
Provider Name (Legal Business Name): DANNY THOMAS FRITTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 POPLAR SPRINGS DR SUITE A
MERIDIAN MS
39305-2678
US

IV. Provider business mailing address

9099A COLLINSVILLE RD
COLLINSVILLE MS
39325-9779
US

V. Phone/Fax

Practice location:
  • Phone: 601-480-5503
  • Fax:
Mailing address:
  • Phone: 601-480-5503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3002
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: