Provider Demographics
NPI:1144428111
Name:FRAZIER, SHARVETTYE ANNGELA (ATC, LAT)
Entity type:Individual
Prefix:
First Name:SHARVETTYE
Middle Name:ANNGELA
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 TIDEWATER TRL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5952
Mailing Address - Country:US
Mailing Address - Phone:813-362-1982
Mailing Address - Fax:
Practice Address - Street 1:3500 E FLETCHER AVE
Practice Address - Street 2:511
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4708
Practice Address - Country:US
Practice Address - Phone:813-396-9627
Practice Address - Fax:813-396-9195
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 22282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer