Provider Demographics
NPI:1013301142
Name:FRAWLEY, SOPHIA (DPT)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:FRAWLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:GERBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4251 LAHMEYER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815
Mailing Address - Country:US
Mailing Address - Phone:260-490-4800
Mailing Address - Fax:
Practice Address - Street 1:7855 SOUTH EMERSON AVENUE
Practice Address - Street 2:SUITE W
Practice Address - City:INDIANEPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237
Practice Address - Country:US
Practice Address - Phone:317-889-5340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002627A2255A2300X
390200000X
IN05013523A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program