Provider Demographics
NPI:1134498991
Name:ESTILL, RALPH WILLIAM (LMP, MMP)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:WILLIAM
Last Name:ESTILL
Suffix:
Gender:M
Credentials:LMP, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 REED ST
Mailing Address - Street 2:STE A
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1165
Mailing Address - Country:US
Mailing Address - Phone:360-421-2476
Mailing Address - Fax:360-899-5260
Practice Address - Street 1:820 REED ST
Practice Address - Street 2:STE A
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1165
Practice Address - Country:US
Practice Address - Phone:360-421-2476
Practice Address - Fax:360-899-5260
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60237912225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist