Provider Demographics
NPI:1285093286
Name:FRAZER, BRYANA (PTA)
Entity type:Individual
Prefix:
First Name:BRYANA
Middle Name:
Last Name:FRAZER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 MASTERS DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3349
Mailing Address - Country:US
Mailing Address - Phone:361-582-6404
Mailing Address - Fax:
Practice Address - Street 1:1022 PRESIDENTIAL CORRIDOR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-4611
Practice Address - Country:US
Practice Address - Phone:979-567-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2112269225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant