Provider Demographics
NPI:1538318845
Name:FRYXELL, JACQUELYN (PT)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:FRYXELL
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 1:3116 FOSTER LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-5537
Mailing Address - Country:US
Mailing Address - Phone:865-388-8576
Mailing Address - Fax:
Practice Address - Street 1:1520 GROVE ST
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1575
Practice Address - Country:US
Practice Address - Phone:865-458-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT1546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist