Basic Information
| Provider Information | |||||||||
| NPI: | 1942548896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRAZIER | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | HILDA | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1480 PANGBOURNE WAY | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210761376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107999655 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14201 PARK CENTER DR | ||||||||
| Address2: | SUITE 40 | ||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207075217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014980383 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2013 | ||||||||
| LastUpdateDate: | 01/28/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 20728 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.