Healthcare Provider Details

I. General information

NPI: 1043127533
Provider Name (Legal Business Name): SAMUEL LEE FRIEDERICHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SAM FRIEDERICHS

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 SPRING VALLEY RD
BURLINGTON WI
53105-7614
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-971-9300
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17895-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: