Basic Information
| Provider Information | |||||||||
| NPI: | 1760702542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRIEDRICHS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | DPT, CMPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FRIEDRICHS | ||||||||
| OtherFirstName: | TONY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | DPT, CMPT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2315 HIGHWAY K | ||||||||
| Address2: | |||||||||
| City: | O FALLON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633688659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362651505 | ||||||||
| FaxNumber: | 6362662112 | ||||||||
| Practice Location | |||||||||
| Address1: | 2315 HIGHWAY K | ||||||||
| Address2: | |||||||||
| City: | O FALLON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633688659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362651505 | ||||||||
| FaxNumber: | 6362662112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2010 | ||||||||
| LastUpdateDate: | 05/20/2019 | ||||||||
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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 | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 480065284 | 05 | MO | MEDICAID |