Provider Demographics
NPI:1639135882
Name:FRYE, JACQUELINE K (PT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:K
Last Name:FRYE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 E SHIPTON RD
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-9252
Mailing Address - Country:US
Mailing Address - Phone:785-825-8985
Mailing Address - Fax:
Practice Address - Street 1:1000 ELMHURST BLVD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7404
Practice Address - Country:US
Practice Address - Phone:785-825-2911
Practice Address - Fax:785-825-2912
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS927943OtherFIRST GUARD
KS3619OtherPREFERRED HEALTH SYSTEMS
KS140900OtherBLUE CROSS - BLUE SHIELD
KSP00217799OtherRAILROAD MEDICARE
KS140900Medicare ID - Type Unspecified