Provider Demographics
NPI:1841298874
Name:FRYE, LISA ANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANNE
Last Name:FRYE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4346
Mailing Address - Country:US
Mailing Address - Phone:513-233-4360
Mailing Address - Fax:513-233-4361
Practice Address - Street 1:7575 5 MILE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4346
Practice Address - Country:US
Practice Address - Phone:513-233-4360
Practice Address - Fax:513-233-4361
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT 09424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9342359OtherPHCS
OH000000328339OtherANTHEM
OH2507059Medicaid
OHP00332377OtherMEDICARE RAILROAD
OH000000328339OtherANTHEM
OH9342359OtherPHCS
OHQ21597Medicare UPIN
OH0225920002Medicare NSC