Provider Demographics
NPI:1154775492
Name:BARRERA, ROSANNA (PT)
Entity type:Individual
Prefix:
First Name:ROSANNA
Middle Name:
Last Name:BARRERA
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 1:7703 N LAMAR BLVD STE 122
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1056
Mailing Address - Country:US
Mailing Address - Phone:512-407-8766
Mailing Address - Fax:512-407-8767
Practice Address - Street 1:7703 N LAMAR BLVD STE 122
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1056
Practice Address - Country:US
Practice Address - Phone:512-407-8766
Practice Address - Fax:512-407-8767
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1180053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1180053OtherPT LICENSE#