Healthcare Provider Details

I. General information

NPI: 1184542185
Provider Name (Legal Business Name): GRACE FRAZIER DPT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17055 FRANCES ST STE 100
OMAHA NE
68130-4655
US

IV. Provider business mailing address

516 N SHORE DR
KENDALLVILLE IN
46755-2640
US

V. Phone/Fax

Practice location:
  • Phone: 402-280-3555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: