Provider Demographics
NPI:1851350870
Name:FRICKE, JOSEPH JOHN (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JOHN
Last Name:FRICKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 NE HALSEY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2096
Mailing Address - Country:US
Mailing Address - Phone:503-257-9881
Mailing Address - Fax:503-257-8964
Practice Address - Street 1:11300 NE HALSEY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2096
Practice Address - Country:US
Practice Address - Phone:503-257-9881
Practice Address - Fax:503-257-8964
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16602251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR104781Medicare UPIN