=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669104501
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRAZIER PHYSICAL THERAPY AND PERSONAL TRAINING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2022
-----------------------------------------------------
Last Update Date | 06/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7716 MIRACLE LN
-----------------------------------------------------
City | NORTH RICHLAND HILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76182-9204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-882-2433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7716 MIRACLE LN
-----------------------------------------------------
City | NORTH RICHLAND HILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76182-9204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-882-2433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | JUSTIN FRAZIER
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 210-882-2433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------