Provider Demographics
NPI:1427392463
Name:FRAZEE, AMY (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FRAZEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6290 JUPITER AVE NE STE C
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-8885
Mailing Address - Country:US
Mailing Address - Phone:616-634-3290
Mailing Address - Fax:616-364-3299
Practice Address - Street 1:6290 JUPITER AVE NE STE C
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MI
Practice Address - Zip Code:49306-8885
Practice Address - Country:US
Practice Address - Phone:616-364-3290
Practice Address - Fax:616-364-3299
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011431A225100000X
VA2305207692225100000X
MI5501018140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist