Provider Demographics
NPI:1831658624
Name:FRIELING, KORI (LMT)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:FRIELING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 SEQUOIA RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-1015
Mailing Address - Country:US
Mailing Address - Phone:303-396-8787
Mailing Address - Fax:
Practice Address - Street 1:2478 PATTERSON RD STE 13
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-3606
Practice Address - Country:US
Practice Address - Phone:970-241-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0013854225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist