Provider Demographics
NPI:1336367812
Name:FRITTS, DANNY THOMAS
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:THOMAS
Last Name:FRITTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9099A COLLINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39325-9779
Mailing Address - Country:US
Mailing Address - Phone:601-480-5503
Mailing Address - Fax:
Practice Address - Street 1:4820 POPLAR SPRINGS DR
Practice Address - Street 2:SUITE A
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2678
Practice Address - Country:US
Practice Address - Phone:601-480-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist