Individual provider Active NPI

Justin Frazier

  • Physical Therapist
  • Southlake, TX
National Provider Identifier
1144865163
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1321645 Issued in TX
Practice address
190 SH-114 W
Southlake, TX 75609
Phone
(210) 882-2433
NPI assigned
Nov 13, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1321645 TX Primary

Addresses

Primary practice location

190 SH-114 W
Southlake, TX 75609

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221220001162 TX Practitioner - Physical Therapist in Private Practice 1153790811 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ideal Physical Therapy of Texas LLCGroup PAC ID 0547583809, 359 clinicians

Practice addresses (Care Compare)

1288 W Main St
Suite 148
Lewisville, TX 75067-3468
Phone (469) 496-3992

Merit-based Incentive Payment System (MIPS)

Final score
85.56 of 100Reported as group
Quality
89.48
Improvement activities
40
Cost
71.16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1321645TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ideal Physical Therapy of Texas LLC CurrentSince Sep 26, 2022 Accepting new patients
Ideal Physical Therapy of Texas LLC Physical Therapist CurrentSince Sep 26, 2022 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

17051 Dallas Pkwy
Ste 450
Addison, TX 75001
Phone (214) 272-8561

5335 W Sublett Rd
Ste 151
Arlington, TX 76017
Phone (817) 839-9150

1827 SW Green Oaks Blvd
Ste 143
Arlington, TX 76017
Phone (512) 501-4783

3000 FM 407 E
Ste 500
Bartonville, TX 76226
Phone (940) 448-2007

6080 Southwest Blvd
Benbrook, TX 76109
Phone (817) 731-9331

4100 Fairway Dr
Ste 400
Carrollton, TX 75010
Phone (972) 394-3325

4843 Colleyville Blvd
Ste 221
Colleyville, TX 76034
Phone (817) 576-7520

5017 Teasley Ln
Ste 161
Denton, TX 76210
Phone (940) 220-2283

1050 Flower Mound Rd
Ste 140
Flower Mound, TX 75028
Phone (469) 702-5947

7410 McCart Ave
Ste 108
Fort Worth, TX 76133
Phone (682) 350-4318

1540 Eastchase Pkwy
Ste 4A
Fort Worth, TX 76120

4617 W Bailey Boswell Rd
Fort Worth, TX 76179
Phone (682) 350-4106

7260 Blue Mound Rd
Ste 146
Fort Worth, TX 76131
Phone 68228593508830

2600 W 7th St
Ste 137
Fort Worth, TX 76107
Phone (682) 233-6462

217 E Bonds Ranch Rd
Fort Worth, TX 76131
Phone (682) 285-9310

1401 William D Tate Ave
Ste 300
Grapevine, TX 76051
Phone (817) 527-3377

861 North Tarrant Pkwy
Unit 100
Keller, TX 76248
Phone (817) 918-2480

1288 W Main St
Ste 148
Lewisville, TX 75067
Phone (469) 496-3992

3141 E Broad St
Ste 111
Mansfield, TX 76063
Phone (817) 435-5248

5121 Rufe Snow Dr
Ste 110
North Richland Hills, TX 76180
Phone (817) 345-4367

3903 Wiseman Blvd
Ste 311
San Antonio, TX 78251
Phone (210) 593-0578

245 W State Highway 114
Ste 320
Southlake, TX 76092
Phone (817) 873-5311

5400 Brodie Ln
Ste 295
Sunset Valley, TX 78745
Phone (512) 676-3949

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1144865163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 SH-114 W",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "75609",
            "telephone_number": "210-882-2433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRAZIER",
        "first_name": "JUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-13",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1321645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.