Healthcare Provider Details

I. General information

NPI: 1790944890
Provider Name (Legal Business Name): ROBERT FRUMHOFF L.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W SANTA FE AVE
FLAGSTAFF AZ
86001-5318
US

IV. Provider business mailing address

13 E RIDGECREST DR
FLAGSTAFF AZ
86001-6714
US

V. Phone/Fax

Practice location:
  • Phone: 928-779-0563
  • Fax:
Mailing address:
  • Phone: 928-779-0563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT04465P
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: