Provider Demographics
NPI:1417356239
Name:FRAZIER, HOPE
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 STATE ROAD 54 W
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47462-5148
Mailing Address - Country:US
Mailing Address - Phone:812-653-6348
Mailing Address - Fax:
Practice Address - Street 1:7050 STATE ROAD 54 W
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:IN
Practice Address - Zip Code:47462-5148
Practice Address - Country:US
Practice Address - Phone:812-653-6348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21003380225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist