Provider Demographics
NPI:1336894930
Name:PENA, ESTRELLA JANE A (PT)
Entity Type:Individual
Prefix:
First Name:ESTRELLA JANE
Middle Name:A
Last Name:PENA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:787 BELLSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2220
Mailing Address - Country:US
Mailing Address - Phone:904-476-5365
Mailing Address - Fax:
Practice Address - Street 1:PENNEY FARMS 3 PAVILLION PLACE 3495 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043
Practice Address - Country:US
Practice Address - Phone:904-284-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist