Provider Demographics
NPI:1619730819
Name:FRAZIER, KATE MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:MARIE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 NW STATE ROUTE 131
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MO
Mailing Address - Zip Code:64040-9470
Mailing Address - Country:US
Mailing Address - Phone:816-726-1376
Mailing Address - Fax:
Practice Address - Street 1:500 NW MURRAY RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1455
Practice Address - Country:US
Practice Address - Phone:816-347-2738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008026537225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant