Provider Demographics
NPI:1386401339
Name:FRASER, EMILY (DPT)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:FRASER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5051 W HIGHLAND KNOLLS RD APT 319
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-3076
Mailing Address - Country:US
Mailing Address - Phone:913-634-0483
Mailing Address - Fax:
Practice Address - Street 1:5320 W SUNSET AVE STE 168
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4410
Practice Address - Country:US
Practice Address - Phone:479-364-6467
Practice Address - Fax:479-239-5444
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist