Provider Demographics
NPI:1922461524
Name:FRIED, MECHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:MECHELLE
Middle Name:
Last Name:FRIED
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 1:3432 S AKRON ST
Mailing Address - Street 2:APT 35
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4695
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6825 E HAMPDEN AVE STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-3000
Practice Address - Country:US
Practice Address - Phone:720-705-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT-10770225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist