Provider Demographics
NPI:1982366894
Name:AGUILAR, STEPHANIE ESTRELLA (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ESTRELLA
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 TRAE ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-2367
Mailing Address - Country:US
Mailing Address - Phone:214-603-7948
Mailing Address - Fax:
Practice Address - Street 1:105 TRAE ST
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-2367
Practice Address - Country:US
Practice Address - Phone:214-603-7948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT135623225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist