Provider Demographics
NPI:1194346833
Name:ESTRELLA, BONHOEFFER (PT)
Entity type:Individual
Prefix:MR
First Name:BONHOEFFER
Middle Name:
Last Name:ESTRELLA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 LIVORNO CT
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8441
Mailing Address - Country:US
Mailing Address - Phone:317-457-5306
Mailing Address - Fax:
Practice Address - Street 1:410 EASTWOOD AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-3167
Practice Address - Country:US
Practice Address - Phone:209-239-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist