Provider Demographics
NPI:1932688140
Name:ESTRADA, YBELISES (PTA)
Entity Type:Individual
Prefix:
First Name:YBELISES
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25925 SW 143RD CT APT 921
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8956
Mailing Address - Country:US
Mailing Address - Phone:786-337-0712
Mailing Address - Fax:
Practice Address - Street 1:8900 CORAL WAY STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2075
Practice Address - Country:US
Practice Address - Phone:305-392-0765
Practice Address - Fax:786-618-5219
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28015225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant