Healthcare Provider Details

I. General information

NPI: 1710072020
Provider Name (Legal Business Name): JASON THAD STRACKER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 E WALNUT ST STE 240
PASADENA CA
91106-1451
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 626-795-2390
  • Fax: 626-795-2391
Mailing address:
  • Phone: 714-514-1799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 29614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: