Provider Demographics
NPI:1841478104
Name:FRAAS, KEITH CHARLES (PT)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:CHARLES
Last Name:FRAAS
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 1:12 CREEKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9386
Mailing Address - Country:US
Mailing Address - Phone:716-685-8872
Mailing Address - Fax:
Practice Address - Street 1:1025 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1755
Practice Address - Country:US
Practice Address - Phone:716-822-4781
Practice Address - Fax:716-825-5765
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020731-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist