Provider Demographics
NPI:1467042010
Name:FRALEY, DEANA BRETT
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:BRETT
Last Name:FRALEY
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 1:1250 LINFORD LN APT 16
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-3907
Mailing Address - Country:US
Mailing Address - Phone:661-616-8981
Mailing Address - Fax:
Practice Address - Street 1:1250 LINFORD LN APT 16
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3907
Practice Address - Country:US
Practice Address - Phone:661-616-8981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75834225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist