Provider Demographics
NPI:1760761688
Name:DIAZ, ESTRELLE ROMINA GERONIMO (RPT)
Entity Type:Individual
Prefix:
First Name:ESTRELLE ROMINA
Middle Name:GERONIMO
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32618 W ALBEMARLE CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-4824
Mailing Address - Country:US
Mailing Address - Phone:620-603-3359
Mailing Address - Fax:
Practice Address - Street 1:32618 W ALBEMARLE CT
Practice Address - Street 2:SUITE 100
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-4824
Practice Address - Country:US
Practice Address - Phone:620-603-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10002619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist