Healthcare Provider Details

I. General information

NPI: 1043481542
Provider Name (Legal Business Name): CATHERINE A FRASER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MAPLETON AVE
BOULDER CO
80304-3979
US

IV. Provider business mailing address

345 MAXWELL AVE
BOULDER CO
80304-3972
US

V. Phone/Fax

Practice location:
  • Phone: 303-544-5700
  • Fax: 303-544-5710
Mailing address:
  • Phone: 303-544-5783
  • Fax: 303-441-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPTL.0005800
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: