Provider Demographics
NPI:1174953160
Name:FREER THERAPEUTICS
Entity type:Organization
Organization Name:FREER THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:FREER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:845-750-3940
Mailing Address - Street 1:231 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5030
Mailing Address - Country:US
Mailing Address - Phone:845-481-3950
Mailing Address - Fax:
Practice Address - Street 1:231 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5030
Practice Address - Country:US
Practice Address - Phone:845-481-3950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018034-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty