Provider Demographics
NPI:1336352764
Name:FRAZIER, LEAH D (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:D
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14154
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-0003
Mailing Address - Country:US
Mailing Address - Phone:757-349-6652
Mailing Address - Fax:757-240-4021
Practice Address - Street 1:11847 CANON BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2579
Practice Address - Country:US
Practice Address - Phone:757-349-6652
Practice Address - Fax:757-240-4021
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204838225100000X
VA0019004844225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist