Healthcare Provider Details

I. General information

NPI: 1780391185
Provider Name (Legal Business Name): DESMOND FRAZIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 S PINE ISLAND RD
DAVIE FL
33328-5933
US

IV. Provider business mailing address

821 NW 85TH TER APT 2211
PLANTATION FL
33324-1239
US

V. Phone/Fax

Practice location:
  • Phone: 305-501-0231
  • Fax:
Mailing address:
  • Phone: 954-734-0939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT39455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: