Provider Demographics
NPI:1891079380
Name:FRISBY, DAVID L (PTA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:FRISBY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 HEIMEL ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-5835
Mailing Address - Country:US
Mailing Address - Phone:608-385-9177
Mailing Address - Fax:
Practice Address - Street 1:2330 HEIMEL ST
Practice Address - Street 2:
Practice Address - City:SOUTH SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55075-5835
Practice Address - Country:US
Practice Address - Phone:608-385-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA1300225200000X
WI1621-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant