Provider Demographics
NPI:1104441708
Name:ESTRADA, ALDINE MAE (PTA)
Entity type:Individual
Prefix:
First Name:ALDINE MAE
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 GRAYBARK AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-5168
Mailing Address - Country:US
Mailing Address - Phone:559-289-0396
Mailing Address - Fax:
Practice Address - Street 1:111 BARSTOW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-2225
Practice Address - Country:US
Practice Address - Phone:559-299-2591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10151225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant