Provider Demographics
NPI:1952861254
Name:FRAELLO, ANTHONY (CP)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:FRAELLO
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 WILD CHERRY DR STE 13
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1822
Mailing Address - Country:US
Mailing Address - Phone:512-297-2724
Mailing Address - Fax:512-467-4695
Practice Address - Street 1:3503 WILD CHERRY DR STE 13
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-1822
Practice Address - Country:US
Practice Address - Phone:512-297-2724
Practice Address - Fax:512-467-4695
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1806224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist