Provider Demographics
NPI:1134505183
Name:SERRANO, EDWIN CARRASCO
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:CARRASCO
Last Name:SERRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 S FLORES ST STE BASEMENT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-1638
Mailing Address - Country:US
Mailing Address - Phone:210-660-7987
Mailing Address - Fax:210-855-3242
Practice Address - Street 1:1502 S FLORES ST STE BASEMENT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78204-1638
Practice Address - Country:US
Practice Address - Phone:210-660-7987
Practice Address - Fax:210-855-3242
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX12654102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist