Provider Demographics
NPI:1952418329
Name:FRIESE, ANTHONY N (PT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:N
Last Name:FRIESE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-4292
Mailing Address - Country:US
Mailing Address - Phone:715-735-3187
Mailing Address - Fax:715-735-7072
Practice Address - Street 1:3200 SHORE DR
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4292
Practice Address - Country:US
Practice Address - Phone:715-735-3187
Practice Address - Fax:715-735-7072
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40227600Medicaid
WI40227600Medicaid