Provider Demographics
NPI:1083731269
Name:FRIES, AMANDA PATRICIA (ATC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:PATRICIA
Last Name:FRIES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 ROUND TOP CT
Mailing Address - Street 2:APT 3A
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5022
Mailing Address - Country:US
Mailing Address - Phone:410-808-8851
Mailing Address - Fax:
Practice Address - Street 1:5407 ROLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1928
Practice Address - Country:US
Practice Address - Phone:410-323-3800
Practice Address - Fax:410-864-2828
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer