Provider Demographics
NPI:1336796614
Name:FRALEY, JEFFREY R (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:FRALEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 S HAUPT AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4246
Mailing Address - Country:US
Mailing Address - Phone:660-888-8363
Mailing Address - Fax:
Practice Address - Street 1:11509 S FORTUNA RD
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-7857
Practice Address - Country:US
Practice Address - Phone:928-342-8767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist