Provider Demographics
NPI:1184838070
Name:ESTRADA, GENEEKA E (PT)
Entity Type:Individual
Prefix:MRS
First Name:GENEEKA
Middle Name:E
Last Name:ESTRADA
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 1:13315 E CASTLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-1750
Mailing Address - Country:US
Mailing Address - Phone:316-214-4260
Mailing Address - Fax:
Practice Address - Street 1:2700 W 30TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-9100
Practice Address - Country:US
Practice Address - Phone:620-343-9285
Practice Address - Fax:620-340-8320
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1102815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist