Healthcare Provider Details

I. General information

NPI: 1336352764
Provider Name (Legal Business Name): LEAH D FRAZIER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11847 CANON BLVD
NEWPORT NEWS VA
23606-2579
US

IV. Provider business mailing address

PO BOX 14154
NEWPORT NEWS VA
23608-0003
US

V. Phone/Fax

Practice location:
  • Phone: 757-349-6652
  • Fax: 757-240-4021
Mailing address:
  • Phone: 757-349-6652
  • Fax: 757-240-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305204838
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019004844
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: