Healthcare Provider Details

I. General information

NPI: 1083987960
Provider Name (Legal Business Name): TRACY LEE FRITH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 NORTHFIELD RD
MAPLE HEIGHTS OH
44137-3114
US

IV. Provider business mailing address

32107 HAMILTON CT APT 203
SOLON OH
44139-5733
US

V. Phone/Fax

Practice location:
  • Phone: 216-510-4719
  • Fax: 216-510-4772
Mailing address:
  • Phone: 248-705-1652
  • Fax: 216-901-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberOT015511
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: