Provider Demographics
NPI:1437222924
Name:RECREO, ESTELLA H (PT)
Entity Type:Individual
Prefix:
First Name:ESTELLA
Middle Name:H
Last Name:RECREO
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 1:402 S PROSPECTORS RD
Mailing Address - Street 2:SUITE # E
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1659
Mailing Address - Country:US
Mailing Address - Phone:909-860-5382
Mailing Address - Fax:909-860-5384
Practice Address - Street 1:402 S PROSPECTORS RD
Practice Address - Street 2:SUITE # E
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1659
Practice Address - Country:US
Practice Address - Phone:909-860-5382
Practice Address - Fax:909-860-5384
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT14527OtherLICENSE