Provider Demographics
NPI:1114325990
Name:FRY, ADAM GREGORY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:GREGORY
Last Name:FRY
Suffix:
Gender:M
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 1:3649 24TH AVE SE
Mailing Address - Street 2:APT. 7
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-2996
Mailing Address - Country:US
Mailing Address - Phone:405-880-0830
Mailing Address - Fax:
Practice Address - Street 1:724 24TH AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6214
Practice Address - Country:US
Practice Address - Phone:405-447-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist