Provider Demographics
NPI:1215954060
Name:FRY, KARL ERICK (PT, OCS, CSCS)
Entity type:Individual
Prefix:MR
First Name:KARL
Middle Name:ERICK
Last Name:FRY
Suffix:
Gender:M
Credentials:PT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8042 WATTS ROAD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719
Mailing Address - Country:US
Mailing Address - Phone:608-265-7500
Mailing Address - Fax:608-261-1760
Practice Address - Street 1:8042 WATTS ROAD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719
Practice Address - Country:US
Practice Address - Phone:608-265-7500
Practice Address - Fax:608-261-1760
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5854-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5854-024OtherPT