Provider Demographics
NPI:1093338014
Name:FRITH, CORY JOSEPH (LAT/ATC/CAFS)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:JOSEPH
Last Name:FRITH
Suffix:
Gender:M
Credentials:LAT/ATC/CAFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 N TRAHAN AVE
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-2226
Mailing Address - Country:US
Mailing Address - Phone:337-652-6310
Mailing Address - Fax:
Practice Address - Street 1:1307 OLD JEANERETTE RD
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-5801
Practice Address - Country:US
Practice Address - Phone:337-652-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.2003142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer