Provider Demographics
NPI:1790198174
Name:ESTRADA-BROOKS, LARIJEAN (DPT, CLT)
Entity type:Individual
Prefix:DR
First Name:LARIJEAN
Middle Name:
Last Name:ESTRADA-BROOKS
Suffix:
Gender:F
Credentials:DPT, CLT
Other - Prefix:
Other - First Name:LARIJEAN
Other - Middle Name:
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41994 CEDAR POINT PL
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-2693
Mailing Address - Country:US
Mailing Address - Phone:703-826-5678
Mailing Address - Fax:833-283-0249
Practice Address - Street 1:44355 PREMIER PLZ STE 120
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5050
Practice Address - Country:US
Practice Address - Phone:703-826-5678
Practice Address - Fax:833-283-0249
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23055211182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist