Healthcare Provider Details

I. General information

NPI: 1902714439
Provider Name (Legal Business Name): ERIC BESTAVROS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 CORNERWOOD DR
AUSTIN TX
78717-4927
US

IV. Provider business mailing address

8005 CORNERWOOD DR
AUSTIN TX
78717-4927
US

V. Phone/Fax

Practice location:
  • Phone: 512-238-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2147362
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: