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NPI Code Detail

MEDICARE: MS. HOLLY DIANE FRY ATC

MEDICARE: MS. HOLLY DIANE FRY ATC
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1548596760
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. HOLLY DIANE FRY ATC
Provider Business Mailing Address
First Line : 632 N NEVADA AVE APT 4
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80903-1024
Country : US
Telephone Number : 303-909-7881
Fax Number :
Provider Business Practice Location Address
First Line : 14 E CACHE LA POUDRE ST
Second Line : EL POMAR - ATHLETICS
City : COLORADO SPRINGS
State : CO
Zip : 80903-3243
Country : US
Telephone Number : 719-389-6990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2009
Last Update Date : 10/22/2009

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Directions to “ MS. HOLLY DIANE FRY ATC” Practice Location

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