Healthcare Provider Details

I. General information

NPI: 1093998650
Provider Name (Legal Business Name): SHERWIN LARRACAS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BARTON CREEK BLVD
AUSTIN TX
78735-1603
US

IV. Provider business mailing address

8721 FOGGY MOUNTAIN DR
AUSTIN TX
78736-3370
US

V. Phone/Fax

Practice location:
  • Phone: 512-610-9401
  • Fax: 512-329-3282
Mailing address:
  • Phone: 512-301-3103
  • Fax: 512-301-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1121242
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number1121242
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: