Provider Demographics
NPI:1851015556
Name:ESTOQUE, RAYNON CORRE (PTA)
Entity Type:Individual
Prefix:
First Name:RAYNON
Middle Name:CORRE
Last Name:ESTOQUE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2101 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6127
Mailing Address - Country:US
Mailing Address - Phone:956-687-4559
Mailing Address - Fax:956-618-1342
Practice Address - Street 1:2483 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4391
Practice Address - Country:US
Practice Address - Phone:830-776-5191
Practice Address - Fax:830-776-5205
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX2161533225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant