Provider Demographics
NPI:1760702542
Name:FRIEDRICHS, DAVID (DPT, CMPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FRIEDRICHS
Suffix:
Gender:M
Credentials:DPT, CMPT
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:FRIEDRICHS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT, CMPT
Mailing Address - Street 1:2315 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8659
Mailing Address - Country:US
Mailing Address - Phone:636-265-1505
Mailing Address - Fax:636-266-2112
Practice Address - Street 1:2315 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8659
Practice Address - Country:US
Practice Address - Phone:636-265-1505
Practice Address - Fax:636-266-2112
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO480065284Medicaid