Healthcare Provider Details

I. General information

NPI: 1043412810
Provider Name (Legal Business Name): ERIKA BRASSOW PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 FM 3237
WIMBERLEY TX
78676-5311
US

IV. Provider business mailing address

112 GOLFCREST DR
WIMBERLEY TX
78676-3034
US

V. Phone/Fax

Practice location:
  • Phone: 512-847-5540
  • Fax:
Mailing address:
  • Phone: 512-618-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number1162067
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: