Provider Demographics
NPI:1093998650
Name:LARRACAS, SHERWIN (PT)
Entity Type:Individual
Prefix:
First Name:SHERWIN
Middle Name:
Last Name:LARRACAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8721 FOGGY MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-3370
Mailing Address - Country:US
Mailing Address - Phone:512-301-3103
Mailing Address - Fax:512-301-3103
Practice Address - Street 1:2500 BARTON CREEK BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-1603
Practice Address - Country:US
Practice Address - Phone:512-610-9401
Practice Address - Fax:512-329-3282
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1121242225100000X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist