Provider Demographics
NPI:1528284320
Name:ESTUESTA, REYNALDO DE VERA (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:DE VERA
Last Name:ESTUESTA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 FOX HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-4936
Mailing Address - Country:US
Mailing Address - Phone:609-350-8773
Mailing Address - Fax:
Practice Address - Street 1:49 BETHEL RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-1601
Practice Address - Country:US
Practice Address - Phone:609-904-9404
Practice Address - Fax:609-904-9407
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA01013900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist