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NPI Code Detail

MEDICARE: KARINA LARA D.P.T.

MEDICARE: KARINA LARA D.P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist34453CA
2225100000XPhysical Therapist1196580TX

General Provider Information

NPI Number : 1780852400
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARINA LARA D.P.T.
Provider Business Mailing Address
First Line : 1704 JEFFERSON ST
Second Line :
City : KERRVILLE
State : TX
Zip : 78028-4710
Country : US
Telephone Number : 830-377-7948
Fax Number :
Provider Business Practice Location Address
First Line : 34910 I-10 WEST
Second Line : STE 401
City : BOERNE
State : TX
Zip : 78006-2813
Country : US
Telephone Number : 830-816-2611
Fax Number : 830-816-2688
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2008
Last Update Date : 08/22/2014

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