Provider Demographics
NPI:1699856690
Name:ESTRADA, MARIO A (RPTA)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:A
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:RPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6412 W CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5040
Mailing Address - Country:US
Mailing Address - Phone:813-390-4098
Mailing Address - Fax:
Practice Address - Street 1:6412 W CLIFTON ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5040
Practice Address - Country:US
Practice Address - Phone:813-390-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA9265225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant