Provider Demographics
NPI:1578633517
Name:FRY, KIM SHARI (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:SHARI
Last Name:FRY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 SEDGWICK DR
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17316-9350
Mailing Address - Country:US
Mailing Address - Phone:717-259-1343
Mailing Address - Fax:
Practice Address - Street 1:7335 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:YORK SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17372-8807
Practice Address - Country:US
Practice Address - Phone:717-528-4113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000733A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer