Provider Demographics
NPI:1235583030
Name:FRARE, JOEY (LAT)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:FRARE
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5617 TREGO ST
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-1436
Mailing Address - Country:US
Mailing Address - Phone:469-363-1937
Mailing Address - Fax:
Practice Address - Street 1:5617 TREGO ST
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-1436
Practice Address - Country:US
Practice Address - Phone:469-363-1937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT60972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2255A2300XOtherI DON'T KNOW