Provider Demographics
NPI:1922076033
Name:FRY, LORELL KAROL (PT)
Entity Type:Individual
Prefix:MRS
First Name:LORELL
Middle Name:KAROL
Last Name:FRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3856 W SHARON LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9327
Mailing Address - Country:US
Mailing Address - Phone:414-423-1624
Mailing Address - Fax:
Practice Address - Street 1:3856 W SHARON LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9327
Practice Address - Country:US
Practice Address - Phone:414-423-1624
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2762-0242251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics