Provider Demographics
NPI:1023397486
Name:PEDROSA, ERIC (CTRS)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:PEDROSA
Suffix:
Gender:M
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12309 ZELLER LANE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753
Mailing Address - Country:US
Mailing Address - Phone:512-680-7862
Mailing Address - Fax:
Practice Address - Street 1:12309 ZELLER LANE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753
Practice Address - Country:US
Practice Address - Phone:512-680-7862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 174H00000X, 221700000X, 222Q00000X, 225600000X, 225A00000X, 225C00000X
59165225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor