Healthcare Provider Details

I. General information

NPI: 1528651973
Provider Name (Legal Business Name): DEVIN D FREDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10526 W PARMER LN STE 403
AUSTIN TX
78717-5057
US

IV. Provider business mailing address

7505 N LOOP 1604 E STE 101
LIVE OAK TX
78233-2604
US

V. Phone/Fax

Practice location:
  • Phone: 512-900-3302
  • Fax: 512-900-3321
Mailing address:
  • Phone: 210-590-4000
  • Fax: 210-590-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: