Provider Demographics
NPI:1720569437
Name:CARRASCO, VERONICA M (DPT)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:M
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 FIELDER NORTH PLZ
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2309
Mailing Address - Country:US
Mailing Address - Phone:812-461-4257
Mailing Address - Fax:817-461-4865
Practice Address - Street 1:520 FIELDER NORTH PLZ
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2309
Practice Address - Country:US
Practice Address - Phone:812-461-4257
Practice Address - Fax:817-461-4865
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1307126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist