MEDICARE: SHAYLA M FRAKES PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	1442	NE

General Provider Information

NPI Number	:	1063887479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYLA M FRAKES PTA

Provider Business Mailing Address
First Line	:	2307 OSBORNE DR W
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-9116
Country	:	US
Telephone Number	:	402-462-2665
Fax Number	:	402-462-2668

Provider Business Practice Location Address
First Line	:	2307 OSBORNE DR W
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-9116
Country	:	US
Telephone Number	:	402-462-2665
Fax Number	:	402-462-2668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	12/10/2015

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