Provider Demographics
NPI:1740332634
Name:FRYBERGER, STEVE M (MAT, ATC, NREMT)
Entity type:Individual
Prefix:MR
First Name:STEVE
Middle Name:M
Last Name:FRYBERGER
Suffix:
Gender:M
Credentials:MAT, ATC, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 OHIO AVE SW
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-4325
Mailing Address - Country:US
Mailing Address - Phone:605-352-5006
Mailing Address - Fax:
Practice Address - Street 1:2353 OHIO AVE SW
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-4325
Practice Address - Country:US
Practice Address - Phone:605-352-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD00682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer