Provider Demographics
NPI:1558870980
Name:ESTES, DENISE ANN (LMT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:ESTES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:ANN
Other - Last Name:WARP-ESTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:SAEGERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:16433-0475
Mailing Address - Country:US
Mailing Address - Phone:814-573-1977
Mailing Address - Fax:
Practice Address - Street 1:179 BROAD ST
Practice Address - Street 2:P O BOX 475
Practice Address - City:SAEGERTOWN
Practice Address - State:PA
Practice Address - Zip Code:16433
Practice Address - Country:US
Practice Address - Phone:814-573-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG003048225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA$$$$$$$$$OtherMEDICARE