Healthcare Provider Details

I. General information

NPI: 1962213934
Provider Name (Legal Business Name): JASON MICHAEL FRIIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 S STADIUM DR
COLUMBIA SC
29208-4019
US

IV. Provider business mailing address

5000 FOREST DR
COLUMBIA SC
29206-5097
US

V. Phone/Fax

Practice location:
  • Phone: 631-295-6667
  • Fax:
Mailing address:
  • Phone: 631-295-6667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATH2271
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: