Individual
MR. MARK FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
908 N PEARL ST, PAOLA, KS 66071-1140
(913) 294-4308
Mailing address
908 N PEARL ST, PAOLA, KS 66071-1140
(913) 294-4308
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-03035
KS
Other
Enumeration date
01/08/2015
Last updated
01/08/2015
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