Provider Demographics
NPI:1245423102
Name:FRY, MICHELE (LAC, PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:FRY
Suffix:
Gender:F
Credentials:LAC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12508 ROLLING ROAD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854
Mailing Address - Country:US
Mailing Address - Phone:301-500-8913
Mailing Address - Fax:
Practice Address - Street 1:2233 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 217
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-4104
Practice Address - Country:US
Practice Address - Phone:202-333-5252
Practice Address - Fax:202-333-1159
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC500229171100000X
DCPT871822225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist