Healthcare Provider Details

I. General information

NPI: 1487580270
Provider Name (Legal Business Name): EAST COAST DIAGNOSTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 WINDSOR RDG S
WILLIAMSBURG VA
23188-1435
US

IV. Provider business mailing address

3225 WINDSOR RDG S
WILLIAMSBURG VA
23188-1435
US

V. Phone/Fax

Practice location:
  • Phone: 817-879-7497
  • Fax:
Mailing address:
  • Phone: 817-879-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS ESTEVEZ
Title or Position: AUTHORIZED OFFICIAL
Credential: DPT
Phone: 817-879-7497