Provider Demographics
NPI:1265678684
Name:FRYE, KRISTY L (PT)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:L
Last Name:FRYE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:L
Other - Last Name:BIRTCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:924 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301
Mailing Address - Country:US
Mailing Address - Phone:716-282-2888
Mailing Address - Fax:716-285-7281
Practice Address - Street 1:924 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301
Practice Address - Country:US
Practice Address - Phone:716-282-2888
Practice Address - Fax:716-285-7281
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030980-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist