Provider Demographics
NPI:1194496083
Name:MORALES ESTRADA, NESTOR DAMIAN (PT)
Entity type:Individual
Prefix:
First Name:NESTOR
Middle Name:DAMIAN
Last Name:MORALES ESTRADA
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 1:4701 MONTEREY OAKS BLVD APT 1335
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-0922
Mailing Address - Country:US
Mailing Address - Phone:956-346-9284
Mailing Address - Fax:
Practice Address - Street 1:2100 E MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-1342
Practice Address - Country:US
Practice Address - Phone:512-900-7934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1353569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist