Provider Demographics
NPI:1386032472
Name:MALDONADO, ESTEFANIA C (PT, DPT)
Entity type:Individual
Prefix:
First Name:ESTEFANIA
Middle Name:C
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ESTEFANIA
Other - Middle Name:C
Other - Last Name:RIVADENEIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2900 MAIN ST APT 203
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4241
Mailing Address - Country:US
Mailing Address - Phone:203-727-8875
Mailing Address - Fax:
Practice Address - Street 1:226 MILL HILL AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2826
Practice Address - Country:US
Practice Address - Phone:860-767-7201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-26
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist