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General NPI Number Information
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NPI Number | 1407373772
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Entity Type | Individual
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Provider Name | FRITZ DAVID PETIT-FRERE PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/27/2017
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Last Update Date | 08/27/2017
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Provider Practice Location Address
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Address Line | 137 WILLIS AVE
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City | MINEOLA
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State | NY
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Zip | 11501-2677
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Country | US
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Telephone | 516-833-5880
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Fax |
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Provider Business Mailing Address
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Address Line | 325 CAMBRIDGE AVE
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City | WESTBURY
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State | NY
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Zip | 11590-2302
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Country | US
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Telephone | 917-319-6795
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 041937
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License Number State | NY
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