Provider Demographics
NPI:1053527721
Name:ESTES, LARRY J (PT)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:J
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 1:1620 RHODE ISLAND
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044
Mailing Address - Country:US
Mailing Address - Phone:785-760-1002
Mailing Address - Fax:
Practice Address - Street 1:5350 W 61ST PLACE
Practice Address - Street 2:MISSION SPRINGS
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66205
Practice Address - Country:US
Practice Address - Phone:913-262-8070
Practice Address - Fax:913-262-8070
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11 00611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS32305095OtherBLUE CROSS BLUE SHIELD