Provider Demographics
NPI:1649399882
Name:FRAZIER, BRANDI DANEEN (PTA)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:DANEEN
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 1:928 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:FRAZIERS BOTTOM
Mailing Address - State:WV
Mailing Address - Zip Code:25082-9715
Mailing Address - Country:US
Mailing Address - Phone:304-937-2694
Mailing Address - Fax:
Practice Address - Street 1:590 POPLAR FORK RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9434
Practice Address - Country:US
Practice Address - Phone:304-757-7826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV000725174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist