Provider Demographics
NPI:1861122442
Name:ESTES, ELIZABETH ANN (DPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:ESTES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:ESTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:220 NE 2ND ST APT 302
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4068
Mailing Address - Country:US
Mailing Address - Phone:817-675-9499
Mailing Address - Fax:
Practice Address - Street 1:1401 SW 34TH ST STE 300
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3059
Practice Address - Country:US
Practice Address - Phone:405-793-7885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist