Healthcare Provider Details

I. General information

NPI: 1861237190
Provider Name (Legal Business Name): MR. ERIK PAUL FRECKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ELMWOOD CIR
WEST CARROLLTON OH
45449-2428
US

IV. Provider business mailing address

5700 COACH DR W APT A
DAYTON OH
45440-2743
US

V. Phone/Fax

Practice location:
  • Phone: 937-866-3814
  • Fax:
Mailing address:
  • Phone: 937-626-6213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number07893
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: