Provider Demographics
NPI:1780852400
Name:LARA, KARINA (DPT)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KARINA
Other - Middle Name:
Other - Last Name:ZAPATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1704 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4710
Mailing Address - Country:US
Mailing Address - Phone:830-377-7948
Mailing Address - Fax:
Practice Address - Street 1:34910 I-10 WEST
Practice Address - Street 2:STE 401
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2813
Practice Address - Country:US
Practice Address - Phone:830-816-2611
Practice Address - Fax:830-816-2688
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34453225100000X
TX1196580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX355262YSX4Medicare PIN