Provider Demographics
NPI:1023544939
Name:ESTUESTA, BRITTANY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:ESTUESTA
Suffix:
Gender:F
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 1:170 SW SCALEHOUSE LOOP STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1255
Mailing Address - Country:US
Mailing Address - Phone:541-316-0805
Mailing Address - Fax:541-241-7670
Practice Address - Street 1:170 SW SCALEHOUSE LOOP STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1255
Practice Address - Country:US
Practice Address - Phone:541-316-0805
Practice Address - Fax:541-241-7670
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR194452OtherMEDICARE
OR500725277Medicaid