Provider Demographics
NPI:1447345392
Name:ESTES, JAY RANDALL (PT)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:RANDALL
Last Name:ESTES
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 1:2500 LEGACY DR
Mailing Address - Street 2:STE 118
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:972-377-4111
Mailing Address - Fax:972-377-4148
Practice Address - Street 1:2500 LEGACY DR
Practice Address - Street 2:STE 118
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-377-4111
Practice Address - Fax:972-377-4148
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1098663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A2471Medicare ID - Type Unspecified
TX00565UMedicare ID - Type UnspecifiedGRP