Provider Demographics
NPI:1265120349
Name:FRAZIER, VICTORIA ROSCHELLE (LMT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROSCHELLE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WESTDALE AVE
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-2751
Mailing Address - Country:US
Mailing Address - Phone:803-306-0786
Mailing Address - Fax:
Practice Address - Street 1:113 WESTDALE AVE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2751
Practice Address - Country:US
Practice Address - Phone:803-306-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9240225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty