Provider Demographics
NPI:1275828402
Name:FRAZIER, KIM M (LMT,MMP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:M
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:LMT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 CEDARHURST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4715
Mailing Address - Country:US
Mailing Address - Phone:704-299-3567
Mailing Address - Fax:
Practice Address - Street 1:3301 CEDARHURST DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-4715
Practice Address - Country:US
Practice Address - Phone:704-299-3567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC03356225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist