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Individual
TARA FRAZER
Active
Individual
TARA FRAZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501017030
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0P33780
GROUP PTAN
—
01
—
1538198700
GROUP NPI
—
01
—
5501017030
STATE LICENSE NUMBER
—
01
—
P33780004
IND PTAN
—
Enumeration date
11/21/2014
Last updated
04/26/2016
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