MEDICARE: STACEY FRATE PT

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	225100000X	Physical Therapist	3480	AZ

General Provider Information

NPI Number	:	1336483981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY FRATE PT

Provider Business Mailing Address
First Line	:	5833 W CORRINE DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-1892
Country	:	US
Telephone Number	:	602-809-5559
Fax Number	:

Provider Business Practice Location Address
First Line	:	5833 W CORRINE DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-1892
Country	:	US
Telephone Number	:	602-809-5559
Fax Number	:

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

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	11/20/2012

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Directions to “ STACEY FRATE PT” Practice Location

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