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NPI Code Detail

MEDICARE: RANDOLPH P FRIESER PT

MEDICARE:   RANDOLPH P FRIESER  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
1225100000XPhysical Therapist070004684IL

General Provider Information

NPI Number : 1366466252
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDOLPH P FRIESER PT
Provider Business Mailing Address
First Line : 88 W SCHILLER ST
Second Line : APT 1601
City : CHICAGO
State : IL
Zip : 60610-4966
Country : US
Telephone Number : 312-878-8800
Fax Number :
Provider Business Practice Location Address
First Line : 222 MERCHANDISE MART PLZ
Second Line : SUITE 951
City : CHICAGO
State : IL
Zip : 60654-1103
Country : US
Telephone Number : 312-878-8800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 09/10/2013

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Directions to “ RANDOLPH P FRIESER PT” Practice Location

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