Provider Demographics
NPI:1407848088
Name:TREECE, FRED EDWARD (PT MS)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:EDWARD
Last Name:TREECE
Suffix:
Gender:M
Credentials:PT MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 N GILBERT RD STE 124 PMB 367
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4616
Mailing Address - Country:US
Mailing Address - Phone:480-821-4200
Mailing Address - Fax:480-821-4447
Practice Address - Street 1:1345 E MCKELLIPS RD
Practice Address - Street 2:101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2721
Practice Address - Country:US
Practice Address - Phone:480-827-0495
Practice Address - Fax:480-827-2354
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2019-05-22
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
AZ16002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ60127Medicare ID - Type Unspecified
AZR10438Medicare UPIN