1609547397 NPI number — LOUISE FRAZEE BLACK MCREE P.T.

Table of content: LOUISE FRAZEE BLACK MCREE P.T. (NPI 1609547397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609547397 NPI number — LOUISE FRAZEE BLACK MCREE P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCREE
Provider First Name:
LOUISE
Provider Middle Name:
FRAZEE BLACK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609547397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1236 DRUID ROAD EAST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-442-2236
Provider Business Mailing Address Fax Number:
727-442-2646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 12TH AVE. N.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-898-5001
Provider Business Practice Location Address Fax Number:
727-894-0554
Provider Enumeration Date:
09/23/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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