=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457150419
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH ANN FRIES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2025
-----------------------------------------------------
Last Update Date | 10/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 255 N CENTER RD STE 2
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48638-5889
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-714-9321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 373 N PINE ST
-----------------------------------------------------
City | HEMLOCK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48626-9327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-714-9321
-----------------------------------------------------
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 | 7501002477
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------