MEDICARE: MICHELE FRY L.AC., PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC500229	DC
2	225100000X	Physical Therapist	PT871822	DC

General Provider Information

NPI Number	:	1245423102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE FRY L.AC., PT

Provider Business Mailing Address
First Line	:	12508 ROLLING ROAD
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854
Country	:	US
Telephone Number	:	301-500-8913
Fax Number	:

Provider Business Practice Location Address
First Line	:	2233 WISCONSIN AVE NW
Second Line	:	SUITE 217
City	:	WASHINGTON
State	:	DC
Zip	:	20007-4104
Country	:	US
Telephone Number	:	202-333-5252
Fax Number	:	202-333-1159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	08/25/2015

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