Healthcare Provider Details

I. General information

NPI: 1952418329
Provider Name (Legal Business Name): ANTHONY N FRIESE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SHORE DR
MARINETTE WI
54143-4292
US

IV. Provider business mailing address

3200 SHORE DR
MARINETTE WI
54143-4292
US

V. Phone/Fax

Practice location:
  • Phone: 715-735-3187
  • Fax: 715-735-7072
Mailing address:
  • Phone: 715-735-3187
  • Fax: 715-735-7072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4002
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: