Provider Demographics
NPI:1306692835
Name:ESTES, LORRAINE (PTA)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:ESTES
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 1:146 DELANCEY DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-7622
Mailing Address - Country:US
Mailing Address - Phone:440-785-5784
Mailing Address - Fax:
Practice Address - Street 1:1826 N CRYSTAL LAKE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5905
Practice Address - Country:US
Practice Address - Phone:813-876-8771
Practice Address - Fax:813-333-5414
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA33255208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation