MEDICARE: JAKE FRIEDLAND

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	225100000X	Physical Therapist
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1972067692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAKE FRIEDLAND

Provider Business Mailing Address
First Line	:	19 MAYFAIR CT
Second Line	:
City	:	LITTLE SILVER
State	:	NJ
Zip	:	07739-1238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8350 E EVANS RD STE C2
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-3639
Country	:	US
Telephone Number	:	480-470-9613
Fax Number	:

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

Provider Enumeration Date	:	01/27/2019
Last Update Date	:	04/13/2022

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Directions to “ JAKE FRIEDLAND ” Practice Location

Language	Start Address	Practice Location

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