Provider Demographics
NPI:1730706581
Name:ESTUS, RYAN JAY (DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JAY
Last Name:ESTUS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 N CURLEW DR APT 11307
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83401-1458
Mailing Address - Country:US
Mailing Address - Phone:405-742-7830
Mailing Address - Fax:
Practice Address - Street 1:1615 CURLEW DR
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-4718
Practice Address - Country:US
Practice Address - Phone:208-516-1204
Practice Address - Fax:208-577-6477
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist