Basic Information
| Provider Information | |||||||||
| NPI: | 1114325990 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRY | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | GREGORY | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3649 24TH AVE SE | ||||||||
| Address2: | APT. 7 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730712996 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058800830 | ||||||||
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| Practice Location | |||||||||
| Address1: | 724 24TH AVE NW STE 100 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730696214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054471571 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2014 | ||||||||
| LastUpdateDate: | 12/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4882 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.