Provider Demographics
NPI:1497476634
Name:FRIED, LEVI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:FRIED
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PHEASANT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ND
Mailing Address - Zip Code:58504-9185
Mailing Address - Country:US
Mailing Address - Phone:605-430-2899
Mailing Address - Fax:
Practice Address - Street 1:520 N CANYON ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2320
Practice Address - Country:US
Practice Address - Phone:605-642-7996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist