Provider Demographics
NPI:1669205217
Name:FRAIRE, DOMINIC SEBASTIAN (MSAT, ATC)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:SEBASTIAN
Last Name:FRAIRE
Suffix:
Gender:M
Credentials:MSAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 AQUARENA SPRINGS DR APT 1422C
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-3075
Mailing Address - Country:US
Mailing Address - Phone:956-566-9215
Mailing Address - Fax:
Practice Address - Street 1:850 N HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER ACADEMY
Practice Address - State:TX
Practice Address - Zip Code:76554-2653
Practice Address - Country:US
Practice Address - Phone:254-982-4201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2025-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer