Provider Demographics
NPI:1235788506
Name:FRAZIER, ANNIE LAURIE (PTA)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:LAURIE
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 1:24069 WILDE DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-1507
Mailing Address - Country:US
Mailing Address - Phone:936-689-5592
Mailing Address - Fax:
Practice Address - Street 1:24069 WILDE DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-1507
Practice Address - Country:US
Practice Address - Phone:936-689-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant