Healthcare Provider Details

I. General information

NPI: 1851350870
Provider Name (Legal Business Name): JOSEPH JOHN FRICKE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 NE HALSEY ST SUITE 102
PORTLAND OR
97220-2096
US

IV. Provider business mailing address

11300 NE HALSEY ST SUITE 102
PORTLAND OR
97220-2096
US

V. Phone/Fax

Practice location:
  • Phone: 503-257-9881
  • Fax: 503-257-8964
Mailing address:
  • Phone: 503-257-9881
  • Fax: 503-257-8964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1660
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: