Provider Demographics
NPI:1285866194
Name:FRICKE, MINDY (PT)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:FRICKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-3202
Mailing Address - Country:US
Mailing Address - Phone:203-237-7835
Mailing Address - Fax:203-237-9187
Practice Address - Street 1:158 STATE ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-3202
Practice Address - Country:US
Practice Address - Phone:203-237-7835
Practice Address - Fax:203-237-9187
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist