Provider Demographics
NPI:1811971880
Name:FRAZIER, SCOTT (DPT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 STEVE BERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361
Mailing Address - Country:US
Mailing Address - Phone:981-342-3800
Mailing Address - Fax:918-342-3900
Practice Address - Street 1:1071 W. BLUE STARR DRIVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5421
Practice Address - Country:US
Practice Address - Phone:918-342-3800
Practice Address - Fax:918-342-3900
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1106995225100000X
OK4175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKGROUP CONTRACTOtherTHERAMATRIX
OK300522021OtherMEDICARE GROUP
OKGROUP CONTRACTOtherBEECH STREET
OK73-1601XXXOtherHEALTHCHOICE
OKG3207OtherPREFERRED COMMUNITYCARE
OKGROUP CONTRACTOtherTRICARE/HUMANA
OK73-1601XXXOther1ST HEALTH/COVENTRY