Provider Demographics
NPI:1255505095
Name:ESTELLA, ALBERT EBUE (PT)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:EBUE
Last Name:ESTELLA
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 1:312 CHERRY HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1907
Mailing Address - Country:US
Mailing Address - Phone:732-397-1241
Mailing Address - Fax:
Practice Address - Street 1:870 EAST ROUTE 70
Practice Address - Street 2:CAREONE AT EVESHAM
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-396-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00985900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist