Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305207282 | VA |
NPI | 1003189002 |
---|---|
Provider Name | Paul Frizelle |
First Address | Tampa, FL 33624-1853 |
Second Address | Centreville, VA 20121-2435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2012 |
Last Update Date | 26/12/2017 |