MEDICARE: MICHAEL ANDREW FRAZIER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	0022720	CO

General Provider Information

NPI Number	:	1073396669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ANDREW FRAZIER LMT

Provider Business Mailing Address
First Line	:	4587 HOLLAND ST
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-3034
Country	:	US
Telephone Number	:	720-218-2119
Fax Number	:

Provider Business Practice Location Address
First Line	:	3234 S WADSWORTH BLVD UNIT A
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-5004
Country	:	US
Telephone Number	:	303-955-4882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	08/16/2023

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