Provider Demographics
NPI:1639646169
Name:FRIOT, MISSY A (PTA)
Entity Type:Individual
Prefix:
First Name:MISSY
Middle Name:A
Last Name:FRIOT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MISSY
Other - Middle Name:ANN
Other - Last Name:FRIOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:450 STATE ROUTE 48
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-4320
Mailing Address - Country:US
Mailing Address - Phone:131-556-1601
Mailing Address - Fax:
Practice Address - Street 1:450 STATE ROUTE 48
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-4320
Practice Address - Country:US
Practice Address - Phone:315-561-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011763-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant