Provider Demographics
NPI:1497076210
Name:FRAKES, RICHLYN LARAMIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:RICHLYN
Middle Name:LARAMIE
Last Name:FRAKES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 HIGHWAY 94
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62339-2002
Mailing Address - Country:US
Mailing Address - Phone:217-430-9871
Mailing Address - Fax:
Practice Address - Street 1:2328 HIGHWAY 94
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:IL
Practice Address - Zip Code:62339-2002
Practice Address - Country:US
Practice Address - Phone:217-430-9871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1197907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist