Provider Demographics
NPI:1750271540
Name:FRIESE, SAMUEL LEO (PT, DPT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LEO
Last Name:FRIESE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N496 MILKY WAY
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-3993
Mailing Address - Country:US
Mailing Address - Phone:920-738-2681
Mailing Address - Fax:
Practice Address - Street 1:N496 MILKY WAY
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-3993
Practice Address - Country:US
Practice Address - Phone:920-738-2681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16802-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist