Provider Demographics
NPI:1083676142
Name:FRASER, GEORGE S (PT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:S
Last Name:FRASER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11801 MENAUL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2467
Mailing Address - Country:US
Mailing Address - Phone:505-271-9616
Mailing Address - Fax:505-271-8050
Practice Address - Street 1:11801 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2467
Practice Address - Country:US
Practice Address - Phone:505-271-9616
Practice Address - Fax:505-271-8050
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist