# FREDERIC THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871038273
- **Authorized official:** KRISTA R FREDERIC DPT, OCS, CSCS (OWNER)
- **Authorized official phone:** (301) 421-1125

## Contact information

- **Practice address:** 9881 BROKEN LAND PKWY, SUITE 103, COLUMBIA, MD 21046-1172
- **Practice address phone:** (240) 841-2639
- **Practice address fax:** (301) 500-2175
- **Mailing address:** PO BOX 356, BURTONSVILLE, MD 20866-0356
- **Mailing address phone:** (301) 421-1125
- **Mailing address fax:** (301) 500-2175

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 12/21/2016
- **Last updated:** 12/21/2016