Provider Demographics
NPI:1679775845
Name:FRAZIER-CLARK, JAN (RPT)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:FRAZIER-CLARK
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 OAKDALE DR
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-4609
Mailing Address - Country:US
Mailing Address - Phone:918-766-0784
Mailing Address - Fax:
Practice Address - Street 1:430 BARTLES RD
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:OK
Practice Address - Zip Code:74029-0520
Practice Address - Country:US
Practice Address - Phone:615-896-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist