Provider Demographics
NPI:1326563602
Name:FREDENDALL, ALAN (DPT)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:FREDENDALL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14261 TORREY RD STE C
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3329
Mailing Address - Country:US
Mailing Address - Phone:810-354-5380
Mailing Address - Fax:810-885-8291
Practice Address - Street 1:14261 TORREY RD STE C
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3329
Practice Address - Country:US
Practice Address - Phone:810-354-5380
Practice Address - Fax:810-885-8291
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist