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General NPI Number Information
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NPI Number | 1801770201
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Entity Type | Individual
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Provider Name | DEDRICA STREETER PTA
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Gender | Female
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 2301 LUCIEN WAY STE 325
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City | MAITLAND
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State | FL
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Zip | 32751-7020
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Country | US
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Telephone | 800-774-7785
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Fax |
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Provider Business Mailing Address
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Address Line | 775 QUAIL ROOST DR
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City | QUINCY
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State | FL
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Zip | 32352-9037
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Country | US
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Telephone | 850-841-9310
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA32950
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License Number State | FL
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