Provider Demographics
NPI:1063026748
Name:FRYE, SANDRA NICOLE (LMT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:NICOLE
Last Name:FRYE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5894 LONG BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32234
Mailing Address - Country:US
Mailing Address - Phone:904-945-0539
Mailing Address - Fax:
Practice Address - Street 1:5894 LONG BRANCH RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32234
Practice Address - Country:US
Practice Address - Phone:904-945-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60023225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty