Provider Demographics
NPI:1669784708
Name:PADILLA, LARRY JOE (PT)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:JOE
Last Name:PADILLA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 BABCOCK RD
Mailing Address - Street 2:#817
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4680
Mailing Address - Country:US
Mailing Address - Phone:210-383-1938
Mailing Address - Fax:210-340-0930
Practice Address - Street 1:1751 BABCOCK RD
Practice Address - Street 2:#817
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4680
Practice Address - Country:US
Practice Address - Phone:210-383-1938
Practice Address - Fax:210-340-0930
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1191289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist