Healthcare Provider Details

I. General information

NPI: 1952861254
Provider Name (Legal Business Name): ANTHONY FRAELLO CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 06/17/2023
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3503 WILD CHERRY DR STE 13
AUSTIN TX
78738-1822
US

IV. Provider business mailing address

3503 WILD CHERRY DR STE 13
LAKEWAY TX
78738-1822
US

V. Phone/Fax

Practice location:
  • Phone: 512-297-2724
  • Fax: 512-467-4695
Mailing address:
  • Phone: 512-297-2724
  • Fax: 512-467-4695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number1806
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: