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General NPI Number Information
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NPI Number | 1992355093
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Entity Type | Organization
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Legal Business Name | FRYE SPORTS MEDICINE LLC
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Dates
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Enumeration Date | 09/19/2019
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Last Update Date | 09/19/2019
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Provider Practice Location Address
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Address Line | 2100 N RONALD REAGAN BLVD STE 1060
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City | LONGWOOD
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State | FL
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Zip | 32750-3530
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Country | US
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Telephone | 386-290-7765
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Fax |
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Provider Business Mailing Address
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Address Line | 300 LA CREEK CT
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City | DEBARY
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State | FL
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Zip | 32713-4523
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Country | US
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Telephone | 386-290-7765
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DR. GREG FRYE
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Credential | PT, DPT, SCS
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Telephone | 386-290-7765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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