Provider Demographics
NPI:1447540166
Name:FRY, LINDSAY (PT, DPT)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:FRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3463 MAGIC DR
Mailing Address - Street 2:SUITE 255
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2973
Mailing Address - Country:US
Mailing Address - Phone:210-582-5840
Mailing Address - Fax:210-582-5841
Practice Address - Street 1:3463 MAGIC DR
Practice Address - Street 2:SUITE 255
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2973
Practice Address - Country:US
Practice Address - Phone:210-582-5840
Practice Address - Fax:210-582-5841
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12047202251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207164901Medicaid
TX149984001Medicaid
TX149984001Medicaid
TX676535Medicare PIN