Individual
LA-FERN FRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
512 S 11TH ST, LAKE WALES, FL 33853-4901
(727) 967-2972
Mailing address
PO BOX 702, LAKELAND, FL 33802-0702
(727) 967-2972
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA29246
FL
Other
Enumeration date
03/24/2019
Last updated
03/24/2019
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