Healthcare Provider Details

I. General information

NPI: 1528284320
Provider Name (Legal Business Name): REYNALDO DE VERA ESTUESTA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LACEY RD
WHITING NJ
08759-1325
US

IV. Provider business mailing address

70 FOX HOLLOW DR
MAYS LANDING NJ
08330-4936
US

V. Phone/Fax

Practice location:
  • Phone: 732-313-2944
  • Fax:
Mailing address:
  • Phone: 609-350-8773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT40QA01013900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: