Provider Demographics
NPI:1194230425
Name:FREW, ERIC SCOTT (LMT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:SCOTT
Last Name:FREW
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1843
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-1843
Mailing Address - Country:US
Mailing Address - Phone:970-331-5514
Mailing Address - Fax:
Practice Address - Street 1:150 E BEAVER CREEK BLVD # 106B
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620-5414
Practice Address - Country:US
Practice Address - Phone:970-343-9155
Practice Address - Fax:970-343-9155
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0003743225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist