Provider Demographics
NPI:1174539399
Name:EVERETT, ESTELLE RUTH (PT)
Entity type:Individual
Prefix:
First Name:ESTELLE
Middle Name:RUTH
Last Name:EVERETT
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 1:3223 E SHIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-6904
Mailing Address - Country:US
Mailing Address - Phone:559-225-1029
Mailing Address - Fax:559-225-1043
Practice Address - Street 1:3223 E SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6904
Practice Address - Country:US
Practice Address - Phone:559-225-1029
Practice Address - Fax:559-225-1043
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT10890Medicare UPIN