Provider Demographics
NPI:1477197754
Name:FRAIZER, RONI JO
Entity Type:Individual
Prefix:
First Name:RONI
Middle Name:JO
Last Name:FRAIZER
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 1:3001 JOE DIMAGGIO BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3974
Mailing Address - Country:US
Mailing Address - Phone:512-639-9748
Mailing Address - Fax:
Practice Address - Street 1:2901 CABALLO RANCH BLVD STE 2A
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78641-4637
Practice Address - Country:US
Practice Address - Phone:512-537-1661
Practice Address - Fax:512-729-0404
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-4798799OtherEIN NUMBER