Provider Demographics
NPI:1790198174
Name:ESTRADA-BROOKS, LARIJEAN (RPT)
Entity Type:Individual
Prefix:
First Name:LARIJEAN
Middle Name:
Last Name:ESTRADA-BROOKS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:LARIJEAN
Other - Middle Name:
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4011 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1054
Mailing Address - Country:US
Mailing Address - Phone:301-933-8500
Mailing Address - Fax:855-653-6232
Practice Address - Street 1:4011 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-1054
Practice Address - Country:US
Practice Address - Phone:301-933-8500
Practice Address - Fax:855-653-6232
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist