Provider Demographics
NPI:1639255367
Name:FRAZIER, KRISTA L (MPT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:L
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4576
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-4576
Mailing Address - Country:US
Mailing Address - Phone:336-629-6397
Mailing Address - Fax:336-629-6939
Practice Address - Street 1:600 W SALISBURY ST
Practice Address - Street 2:SUITE A
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5366
Practice Address - Country:US
Practice Address - Phone:336-629-6397
Practice Address - Fax:336-629-6939
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC06716OtherBC/BS
NC2504125OtherMEDICARE