Healthcare Provider Details

I. General information

NPI: 1972672616
Provider Name (Legal Business Name): FREDERICK KATZ LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 STATE ST
MEDFORD OR
97504-8450
US

IV. Provider business mailing address

3156 STATE ST
MEDFORD OR
97504-8450
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-9772
  • Fax: 541-773-1113
Mailing address:
  • Phone: 541-773-9772
  • Fax: 541-773-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10188
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: