Provider Demographics
NPI:1528032463
Name:FREY, MICHAEL W (MSED, ATC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:W
Last Name:FREY
Suffix:
Gender:M
Credentials:MSED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:8700 NW RIVER PARK DR
Mailing Address - Street 2:#1062
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-4358
Mailing Address - Country:US
Mailing Address - Phone:816-584-6353
Mailing Address - Fax:816-505-5474
Practice Address - Street 1:8700 NW RIVER PARK DR
Practice Address - Street 2:#1062
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-4358
Practice Address - Country:US
Practice Address - Phone:816-584-6353
Practice Address - Fax:816-505-5474
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030226942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer