Provider Demographics
NPI:1073803581
Name:FRAZIER, TRACY D (CMT)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:D
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36180 TOULON DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4518
Mailing Address - Country:US
Mailing Address - Phone:951-216-8252
Mailing Address - Fax:
Practice Address - Street 1:36180 TOULON DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4518
Practice Address - Country:US
Practice Address - Phone:951-216-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21523173C00000X, 225700000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist
No174400000XOther Service ProvidersSpecialist