Provider Demographics
NPI:1851377998
Name:ESTES, LAURA D (PT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:D
Last Name:ESTES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WEISBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-2319
Mailing Address - Country:US
Mailing Address - Phone:618-985-2857
Mailing Address - Fax:
Practice Address - Street 1:1100 E CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-2931
Practice Address - Country:US
Practice Address - Phone:618-937-2797
Practice Address - Fax:618-937-2591
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002013615225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist