Provider Demographics
NPI:1225480569
Name:FRIED, STEPHANIE BROOKE (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BROOKE
Last Name:FRIED
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:BROOKE
Other - Last Name:HEYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:9070 KIMBERLY BLVD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434
Mailing Address - Country:US
Mailing Address - Phone:561-482-6900
Mailing Address - Fax:561-482-6023
Practice Address - Street 1:9070 KIMBERLY BLVD
Practice Address - Street 2:SUITE 24
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434
Practice Address - Country:US
Practice Address - Phone:561-482-6900
Practice Address - Fax:561-482-6023
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33059225100000X
KS11-05489225100000X
MO2016033281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist