Provider Demographics
NPI:1801869581
Name:FRICKE, PERRY (ATC)
Entity type:Individual
Prefix:MR
First Name:PERRY
Middle Name:
Last Name:FRICKE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 DRDA LN
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-5802
Mailing Address - Country:US
Mailing Address - Phone:618-659-1946
Mailing Address - Fax:
Practice Address - Street 1:15875 NEW HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-1225
Practice Address - Country:US
Practice Address - Phone:314-953-5400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040264152255A2300X
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer