Provider Demographics
NPI:1831417997
Name:ESTRELLADO, CHRIS EVAN TAGULINAO (PT)
Entity type:Individual
Prefix:
First Name:CHRIS EVAN
Middle Name:TAGULINAO
Last Name:ESTRELLADO
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 1:7605 113TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6568
Mailing Address - Country:US
Mailing Address - Phone:718-575-9800
Mailing Address - Fax:718-575-9707
Practice Address - Street 1:7605 113TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6568
Practice Address - Country:US
Practice Address - Phone:718-575-9800
Practice Address - Fax:718-575-9707
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist