Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1121242 | TX |
Y | 2251G0304X | Physical Therapist - Geriatrics | 1121242 | TX |
NPI | 1093998650 |
---|---|
Provider Name | Sherwin Larracas |
First Address | Austin, TX 78736-3370 |
Second Address | Austin, TX 78735-1603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2007 |
Last Update Date | 06/12/2007 |