Provider Demographics
NPI:1073843397
Name:FRIAS, MINERVA SALOMON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MINERVA
Middle Name:SALOMON
Last Name:FRIAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 MAMARONECK AVE
Mailing Address - Street 2:APARTMENT 2C
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1425 MAMARONECK AVE
Practice Address - Street 2:APARTMENT 2C
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-1245
Practice Address - Country:US
Practice Address - Phone:646-483-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist