Provider Demographics
NPI:1518241348
Name:FREY, MICAH DANIEL (PT)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:DANIEL
Last Name:FREY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 WILLAMETTE FALLS DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4688
Mailing Address - Country:US
Mailing Address - Phone:503-387-5449
Mailing Address - Fax:503-342-6846
Practice Address - Street 1:1914 WILLAMETTE FALLS DR
Practice Address - Street 2:SUITE 230
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4688
Practice Address - Country:US
Practice Address - Phone:503-387-5449
Practice Address - Fax:503-342-6846
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist