Mark Frederick, P.T.
Individual provider Active NPI Physical Therapist · Paola, KS
NPI 1306234604 · NPPES record last updated Jan 8, 2015
Key facts
- NPI
- 1306234604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 11-03035 (KS)
- Practice address
- 908 N Pearl St
Paola, KS 66071-1140 - Phone
- (913) 294-4308
- NPI assigned
- Jan 8, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11-03035 | KS | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11-03035 | KS | Yes |
Addresses
Primary practice location
908 N Pearl St
Paola, KS 66071-1140
Mailing address
908 N Pearl St
Paola, KS 66071-1140
Phone (913) 294-4308
Other providers in Paola, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.