Provider Demographics
NPI:1528012309
Name:STRICKLAND, JERRY
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:STRICKLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2254
Mailing Address - Country:US
Mailing Address - Phone:252-443-9103
Mailing Address - Fax:252-451-9032
Practice Address - Street 1:2413 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2254
Practice Address - Country:US
Practice Address - Phone:252-443-9103
Practice Address - Fax:252-451-9032
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC195866OtherMED RISK
NC2743633OtherUHC
NC068EROtherBCBS
NC7057923OtherAETNA
NC7212406Medicaid
NC197961OtherMEDCOST
NC2743633OtherUHC
NC2509062AMedicare PIN
NC2509062BMedicare PIN