Provider Demographics
NPI:1255385092
Name:ESTES, MICHAEL A (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:ESTES
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9217 TANGELO BLVD
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-3759
Mailing Address - Country:US
Mailing Address - Phone:239-433-0243
Mailing Address - Fax:
Practice Address - Street 1:FLORIDA GULF COAST UNIVERSITY
Practice Address - Street 2:10501 FGCU BLVD. SOUTH
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33965-0001
Practice Address - Country:US
Practice Address - Phone:239-590-7006
Practice Address - Fax:239-590-7398
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL000003142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer