Healthcare Provider Details

I. General information

NPI: 1962734632
Provider Name (Legal Business Name): JODENE STRICKLE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3861 OAKWATER CIR STE 1
ORLANDO FL
32806-6258
US

IV. Provider business mailing address

3096 JUNEBERRY TER
OVIEDO FL
32766-6629
US

V. Phone/Fax

Practice location:
  • Phone: 407-481-8861
  • Fax:
Mailing address:
  • Phone: 321-765-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 14267
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: