Provider Demographics
NPI:1710339122
Name:ESTEVE, MATTHEW (PT,DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ESTEVE
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 WILTON ST
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-5147
Mailing Address - Country:US
Mailing Address - Phone:504-931-7343
Mailing Address - Fax:
Practice Address - Street 1:22415 68TH AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2444
Practice Address - Country:US
Practice Address - Phone:253-395-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-09
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60650849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist