Healthcare Provider Details

I. General information

NPI: 1972696870
Provider Name (Legal Business Name): MARIAN HIGBY FREDAL P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 KNUTSON DR
MADISON WI
53704-1133
US

IV. Provider business mailing address

317 KNUTSON DR
MADISON WI
53704-1133
US

V. Phone/Fax

Practice location:
  • Phone: 608-301-9378
  • Fax: 608-301-9388
Mailing address:
  • Phone: 608-301-9378
  • Fax: 608-301-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1932-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: