MEDICARE: JAE LINDSEY FRAZIER

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	PT60770804	WA

General Provider Information

NPI Number	:	1659728814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAE LINDSEY FRAZIER

Provider Business Mailing Address
First Line	:	97 LONGKILL RD
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-1615
Country	:	US
Telephone Number	:	518-542-2822
Fax Number	:

Provider Business Practice Location Address
First Line	:	3855 DARTMOUTH COLLEGE HWY
Second Line	:
City	:	NORTH HAVERHILL
State	:	NH
Zip	:	03774-4937
Country	:	US
Telephone Number	:	603-787-6971
Fax Number	:

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

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	05/09/2018

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