Provider Demographics
NPI:1396383691
Name:ESTES, PATRICIA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:ESTES
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 1:11099 BENT MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BENT MOUNTAIN
Mailing Address - State:VA
Mailing Address - Zip Code:24059-2125
Mailing Address - Country:US
Mailing Address - Phone:540-874-6969
Mailing Address - Fax:
Practice Address - Street 1:300 HATCHER ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1256
Practice Address - Country:US
Practice Address - Phone:540-483-9261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist