Provider Demographics
NPI:1871267245
Name:ESTRADA, JOSEPH MICHAEL (AAS, PTA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:AAS, PTA
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AAS, PTA
Mailing Address - Street 1:11944 MESQUITE GUM LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3320
Mailing Address - Country:US
Mailing Address - Phone:575-403-7191
Mailing Address - Fax:
Practice Address - Street 1:2114 N ZARAGOZA RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-8122
Practice Address - Country:US
Practice Address - Phone:915-209-2256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2164816225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant