Provider Demographics
NPI:1912486994
Name:FRAUSTO, ADRIAN (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:
Last Name:FRAUSTO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 HARRY WURZBACH RD APT 2211
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3108
Mailing Address - Country:US
Mailing Address - Phone:210-693-5657
Mailing Address - Fax:
Practice Address - Street 1:710 AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1904
Practice Address - Country:US
Practice Address - Phone:210-298-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1309397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty