Provider Demographics
NPI:1629030416
Name:ESTERSON PHYSICAL THERAPY PA
Entity type:Organization
Organization Name:ESTERSON PHYSICAL THERAPY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ESTERSON
Authorized Official - Last Name:ESTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-747-1600
Mailing Address - Street 1:2 W ROLLING CROSSROADS
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6208
Mailing Address - Country:US
Mailing Address - Phone:410-747-1600
Mailing Address - Fax:410-747-5202
Practice Address - Street 1:2 W ROLLING CROSSROADS
Practice Address - Street 2:SUITE 102
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-6208
Practice Address - Country:US
Practice Address - Phone:410-747-1600
Practice Address - Fax:410-747-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD650023403OtherRAILROAD MEDICARE
MD342MMedicare PIN
MD650023403OtherRAILROAD MEDICARE