Provider Demographics
NPI:1063725497
Name:FRECHETTE, LOUIS A (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:A
Last Name:FRECHETTE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:MR
Other - First Name:LOUIS
Other - Middle Name:A
Other - Last Name:FRECHETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4305 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 4305
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-6638
Mailing Address - Country:US
Mailing Address - Phone:315-329-7400
Mailing Address - Fax:315-329-7403
Practice Address - Street 1:4305 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 4305
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6638
Practice Address - Country:US
Practice Address - Phone:315-329-7400
Practice Address - Fax:315-329-7403
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPENDING225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist