MEDICARE: GARY J FRASIER II PT

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	225100000X	Physical Therapist	012052-1	NY

General Provider Information

NPI Number	:	1629373006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY J FRASIER II PT

Provider Business Mailing Address
First Line	:	100 PARK ST
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-4413
Country	:	US
Telephone Number	:	518-926-2000
Fax Number	:	518-926-2020

Provider Business Practice Location Address
First Line	:	135 NORTH RD
Second Line	:
City	:	WILTON
State	:	NY
Zip	:	12831-1308
Country	:	US
Telephone Number	:	518-926-1900
Fax Number	:	518-926-1905

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

Provider Enumeration Date	:	01/17/2011
Last Update Date	:	01/17/2011

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