Provider Demographics
NPI:1356049845
Name:SILLER, FRIDA A
Entity type:Individual
Prefix:
First Name:FRIDA
Middle Name:A
Last Name:SILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-3914
Mailing Address - Country:US
Mailing Address - Phone:804-585-7624
Mailing Address - Fax:
Practice Address - Street 1:11015 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3225
Practice Address - Country:US
Practice Address - Phone:757-595-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605900103TE1100X, 225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports