Basic Information
| Provider Information | |||||||||
| NPI: | 1730706581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESTUS | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | JAY | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 246 N CURLEW DR APT 11307 | ||||||||
| Address2: | |||||||||
| City: | AMMON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834011458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057427830 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1615 CURLEW DR | ||||||||
| Address2: | |||||||||
| City: | AMMON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834064718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085161204 | ||||||||
| FaxNumber: | 2085776477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2020 | ||||||||
| LastUpdateDate: | 05/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6833 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.