Provider Demographics
NPI:1043443419
Name:FRAZIER, CANDACE NICOLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:NICOLE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 PHILLIPS LN
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2144
Mailing Address - Country:US
Mailing Address - Phone:606-864-2788
Mailing Address - Fax:606-864-2797
Practice Address - Street 1:702 PHILLIPS LN
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2144
Practice Address - Country:US
Practice Address - Phone:606-864-2788
Practice Address - Fax:606-864-2797
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02395225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant