Provider Demographics
NPI:1487908091
Name:FRAZIER, MARJORIE (PT)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 RIDGEWOOD CV W
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4210
Mailing Address - Country:US
Mailing Address - Phone:850-897-1545
Mailing Address - Fax:
Practice Address - Street 1:812 RIDGEWOOD CV W
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-4210
Practice Address - Country:US
Practice Address - Phone:850-897-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT65052251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics