Provider Demographics
NPI:1427833292
Name:LARA, ROSALINO EVIER (DPT)
Entity type:Individual
Prefix:
First Name:ROSALINO
Middle Name:EVIER
Last Name:LARA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15331 FORT MARCY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-3188
Mailing Address - Country:US
Mailing Address - Phone:210-387-5220
Mailing Address - Fax:
Practice Address - Street 1:3619 PAESANOS PKWY STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1254
Practice Address - Country:US
Practice Address - Phone:210-399-4836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1383147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist