Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | ||
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1215323498 |
---|---|
Provider Name | Jamaun Frazier |
First Address | Chatsworth, CA 91311-3002 |
Second Address | Chatsworth, CA 91311-3002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 14/04/2015 |