Basic Information
| Provider Information | |||||||||
| NPI: | 1003189002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIZELLE | ||||||||
| FirstName: | PAUL | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3903 NORTHDALE BLVD | ||||||||
| Address2: | STE 111W | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336241853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133454915 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13890 BRADDOCK RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | CENTREVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201212435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038306360 | ||||||||
| FaxNumber: | 7038306362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2012 | ||||||||
| LastUpdateDate: | 12/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305207282 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.