Provider Demographics
NPI:1376505891
Name:FRASER, PATRICIA D (PT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:D
Last Name:FRASER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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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:87112-2420
Mailing Address - Country:US
Mailing Address - Phone:505-271-9616
Mailing Address - Fax:505-271-8050
Practice Address - Street 1:11719 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1790
Practice Address - Country:US
Practice Address - Phone:505-345-8050
Practice Address - Fax:505-343-8050
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist