Provider Demographics
NPI:1952442634
Name:FRAZIER, JENNIFER E (PT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:E
Last Name:FRAZIER
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 1:1850 E PARK AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6705
Mailing Address - Country:US
Mailing Address - Phone:814-865-3566
Mailing Address - Fax:814-863-7803
Practice Address - Street 1:1850 E PARK AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6705
Practice Address - Country:US
Practice Address - Phone:814-865-3566
Practice Address - Fax:814-863-7803
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1425698OtherHIGHMARK BC BS
PA1425698OtherHIGHMARK BC BS