Provider Demographics
NPI:1003189002
Name:FRIZELLE, PAUL (DPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:FRIZELLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 NORTHDALE BLVD
Mailing Address - Street 2:STE 111W
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1853
Mailing Address - Country:US
Mailing Address - Phone:813-345-4915
Mailing Address - Fax:
Practice Address - Street 1:13890 BRADDOCK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2435
Practice Address - Country:US
Practice Address - Phone:703-830-6360
Practice Address - Fax:703-830-6362
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist