Provider Demographics
NPI:1295131084
Name:ESTRELLA, JILLIAN F (PTA)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:F
Last Name:ESTRELLA
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 1:8215 CANARY CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4895 W WATERS AVE
Practice Address - Street 2:SUITE E-J
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1316
Practice Address - Country:US
Practice Address - Phone:813-932-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA24981225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant