=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184211880
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE FRYE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2020
-----------------------------------------------------
Last Update Date | 01/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 464 ROUTE 25A
-----------------------------------------------------
City | MILLER PLACE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11764-2514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-680-9458
-----------------------------------------------------
Fax | 631-736-1332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 761 MIDDLE COUNTRY RD
-----------------------------------------------------
City | SELDEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11784-2550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-736-4064
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 025210-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------