Basic Information
Provider Information
NPI: 1376938019
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRISHMAN
FirstName: DAVID
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 305 NE LOOP 820
Address2: BUSINESS TOWER 1, SUITE 200
City: HURST
State: TX
PostalCode: 760537209
CountryCode: US
TelephoneNumber: 8172928787
FaxNumber: 8177896849
Practice Location
Address1: 5225 S LOOP 289
Address2: SUITE 200
City: LUBBOCK
State: TX
PostalCode: 794241363
CountryCode: US
TelephoneNumber: 8067804180
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/31/2015
LastUpdateDate: 03/31/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X1191881TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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