Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | C15923 | IN |
Y | 225000000X | Orthotic Fitter | C15923 | KY |
NPI | 1376533398 |
---|---|
Provider Name | Greg Frey |
First Address | Louisville, KY 40202-1846 |
Second Address | Louisville, KY 40202-1846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 23/05/2008 |