Provider Demographics
NPI:1922338243
Name:FREDERICK, EILEEN M (PT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:F
Other - Last Name:LEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1921
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-1921
Mailing Address - Country:US
Mailing Address - Phone:407-335-0125
Mailing Address - Fax:
Practice Address - Street 1:3320 STATE ROAD 436
Practice Address - Street 2:SUITE 1010
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6003
Practice Address - Country:US
Practice Address - Phone:407-542-0899
Practice Address - Fax:407-956-2194
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17082225100000X
NY007438-1225100000X
FLPT23726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist