Provider Demographics
NPI:1518271717
Name:FRISKE, KATIE ANN (DPT)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:ANN
Last Name:FRISKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1630 MILITARY CUTOFF RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WSLMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5719
Mailing Address - Country:US
Mailing Address - Phone:910-798-2318
Mailing Address - Fax:910-798-2319
Practice Address - Street 1:1630 MILITARY CUTOFF RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5719
Practice Address - Country:US
Practice Address - Phone:910-798-2318
Practice Address - Fax:910-798-2319
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206580225100000X
NCCP015235T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist