Provider Demographics
NPI:1720555212
Name:ESTRADA, PABLO EDUARDO (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:EDUARDO
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-2630
Mailing Address - Country:US
Mailing Address - Phone:915-444-8116
Mailing Address - Fax:
Practice Address - Street 1:3220 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2630
Practice Address - Country:US
Practice Address - Phone:915-444-8116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12712292081S0010X, 2251X0800X
2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1271229OtherLICENSE
52596OtherBOARD SPECIALTY CERTIFICATE