Healthcare Provider Details

I. General information

NPI: 1649610098
Provider Name (Legal Business Name): STRACKER PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2013
Last Update Date: 06/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 N WANDA RD STE. 120 V4
ORANGE CA
92867-5343
US

IV. Provider business mailing address

1421 N WANDA RD STE. 120 V4
ORANGE CA
92867-5343
US

V. Phone/Fax

Practice location:
  • Phone: 714-865-1076
  • Fax:
Mailing address:
  • Phone: 714-865-1076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT29614
License Number StateCA

VIII. Authorized Official

Name: DR. JASON THAD STRACKER
Title or Position: PRESIDENT
Credential: PT, DPT
Phone: 714-865-1076