Provider Demographics
NPI:1407181340
Name:ESTIRA, MARIANNE BAUTISTA (PT)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:BAUTISTA
Last Name:ESTIRA
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 1:1150 PELHAM PKWY S APT 5A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1034
Mailing Address - Country:US
Mailing Address - Phone:908-514-0439
Mailing Address - Fax:
Practice Address - Street 1:3130 GRAND CONCOURSE STE 1E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1263
Practice Address - Country:US
Practice Address - Phone:212-203-3201
Practice Address - Fax:718-338-2695
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028880OtherLICENSE NUMBER