Provider Demographics
NPI:1629353396
Name:ESTAFANOUS, CHRIS (DPT)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:
Last Name:ESTAFANOUS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13944 GUNNERS PL
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-3533
Mailing Address - Country:US
Mailing Address - Phone:917-734-1080
Mailing Address - Fax:
Practice Address - Street 1:555 13TH STREET NW
Practice Address - Street 2:C112
Practice Address - City:WASHINGTON DC
Practice Address - State:DC
Practice Address - Zip Code:20004
Practice Address - Country:US
Practice Address - Phone:202-347-1800
Practice Address - Fax:202-521-3499
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034175225100000X
VA23052073372251X0800X
DCPT8714672251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist