Provider Demographics
NPI:1952453243
Name:ESTEP, TONYA RENEE (PT)
Entity Type:Individual
Prefix:MISS
First Name:TONYA
Middle Name:RENEE
Last Name:ESTEP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:TONYA
Other - Middle Name:RENEE
Other - Last Name:ESTEP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3104 PINE TOP RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-6202
Mailing Address - Country:US
Mailing Address - Phone:606-862-8333
Mailing Address - Fax:606-862-8618
Practice Address - Street 1:3104 PINE TOP RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6202
Practice Address - Country:US
Practice Address - Phone:606-862-8333
Practice Address - Fax:606-862-8618
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY87000741Medicaid
KY320005165OtherTAX IDENTIFICATION NUMBER
KY5027801Medicare PIN