Provider Demographics
NPI:1740669159
Name:ESTOQUE, ANGELINE
Entity type:Individual
Prefix:
First Name:ANGELINE
Middle Name:
Last Name:ESTOQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4348 N GLOSTER ST APT 11A
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-7251
Mailing Address - Country:US
Mailing Address - Phone:662-680-3148
Mailing Address - Fax:877-276-4918
Practice Address - Street 1:4348 N GLOSTER ST APT 11A
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-7251
Practice Address - Country:US
Practice Address - Phone:662-680-3148
Practice Address - Fax:877-276-4918
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist