Provider Demographics
NPI:1124347828
Name:FROST, PAULA JANE (CMT)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:JANE
Last Name:FROST
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8770 SPRINGBROOK DR NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-6099
Mailing Address - Country:US
Mailing Address - Phone:763-300-8247
Mailing Address - Fax:
Practice Address - Street 1:8770 SPRINGBROOK DR NW STE 100
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-6100
Practice Address - Country:US
Practice Address - Phone:763-300-8247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist