=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154013837
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE L FRY PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2023
-----------------------------------------------------
Last Update Date | 05/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3805 EMERALD PKWY
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43016-3317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-665-9844
-----------------------------------------------------
Fax | 614-655-9792
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2007 TEWKSBURY RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43221-4219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-805-3250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT020386
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------