Provider Demographics
NPI:1962672808
Name:MAROTTA-FRAUSTO, ELSA (PT)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:MAROTTA-FRAUSTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7616 CULEBRA RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1476
Mailing Address - Country:US
Mailing Address - Phone:210-682-2346
Mailing Address - Fax:210-681-7192
Practice Address - Street 1:7616 CULEBRA RD
Practice Address - Street 2:SUITE 115
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1476
Practice Address - Country:US
Practice Address - Phone:210-682-2346
Practice Address - Fax:210-681-7192
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1108868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist