Provider Demographics
NPI:1427468412
Name:FRICK, KELLEY (DPT)
Entity type:Individual
Prefix:MISS
First Name:KELLEY
Middle Name:
Last Name:FRICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 ORLEANS DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-1399
Mailing Address - Country:US
Mailing Address - Phone:603-520-2819
Mailing Address - Fax:
Practice Address - Street 1:3401 PREMIER DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-7087
Practice Address - Country:US
Practice Address - Phone:785-539-7671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1305365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHU02043490 03OtherCIGNA TUFTS HEALTH PLAN