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General NPI Number Information
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NPI Number | 1669808184
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Entity Type | Individual
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Provider Name | RANDI LYNN FREY
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Gender | Female
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 10600 LEWIS AND CLARK BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63136-6005
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Country | US
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Telephone | 314-340-6389
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Fax |
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Provider Business Mailing Address
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Address Line | 2348 KENNEDY LN
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City | HIGHLAND
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State | IL
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Zip | 62249-3847
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Country | US
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Telephone | 618-978-0927
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | .2013000038
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160.004820
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License Number State | IL
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