Provider Demographics
NPI:1356061303
Name:SIERRA REALES, ESTEFANIA (PT)
Entity type:Individual
Prefix:
First Name:ESTEFANIA
Middle Name:
Last Name:SIERRA REALES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 W PECAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-1033
Mailing Address - Country:US
Mailing Address - Phone:512-240-2204
Mailing Address - Fax:
Practice Address - Street 1:2512 W PECAN ST STE 100
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-1033
Practice Address - Country:US
Practice Address - Phone:512-240-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1363665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist