MEDICARE: MR. PERRY S ESTERSON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305001570	VA

General Provider Information

NPI Number	:	1891804910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PERRY S ESTERSON PT

Provider Business Mailing Address
First Line	:	1257 WOODBROOK CT
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20194-1344
Country	:	US
Telephone Number	:	703-787-6620
Fax Number	:

Provider Business Practice Location Address
First Line	:	6565 ARLINGTON BLVD
Second Line	:	220
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-3013
Country	:	US
Telephone Number	:	703-942-8824
Fax Number	:	703-942-8834

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/30/2009

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