Active NPI
Lydia E Estevez, P,T.
- Physical Therapist
- Petaluma, CA
National Provider Identifier
1154480879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 10563
- Practice address
- 3900 Lakeville Hwy
Petaluma, CA 94954-5698 - Phone
- (707) 765-3628
- NPI assigned
- Dec 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 10563 | CA | Primary |
Addresses
Primary practice location
3900 Lakeville Hwy
Petaluma, CA 94954-5698
Mailing address
3900 Lakeville Hwy
Petaluma, CA 94954
Phone (707) 765-3628
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10563 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| PT 10563 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154480879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3900 LAKEVILLE HWY",
"city": "PETALUMA",
"state": "CA",
"postal_code": "94954",
"telephone_number": "707-765-3628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3900 LAKEVILLE HWY",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949545698",
"telephone_number": "707-765-3628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ESTEVEZ",
"first_name": "LYDIA",
"middle_name": "E",
"name_prefix": "Ms.",
"credential": "P,T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT 10563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.