Provider Demographics
NPI:1083852628
Name:FREVERT, EMILY LYNNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:LYNNE
Last Name:FREVERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 E CALLE CEDRO
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3208
Mailing Address - Country:US
Mailing Address - Phone:714-921-0372
Mailing Address - Fax:
Practice Address - Street 1:980 ROOSEVELT STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3670
Practice Address - Country:US
Practice Address - Phone:949-333-6456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA350482251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics