Provider Demographics
NPI:1689770893
Name:HENRY W. STRICKLAND ,JR. MPT P.A.
Entity Type:Organization
Organization Name:HENRY W. STRICKLAND ,JR. MPT P.A.
Other - Org Name:LASER PHYSICAL THERAPY & SPORTSMEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:386-748-2458
Mailing Address - Street 1:207 OAKAPPLE TRAIL
Mailing Address - Street 2:
Mailing Address - City:LAKE HELEN
Mailing Address - State:FL
Mailing Address - Zip Code:32744
Mailing Address - Country:US
Mailing Address - Phone:386-748-2458
Mailing Address - Fax:866-509-2191
Practice Address - Street 1:207 OAKAPPLE TRAIL
Practice Address - Street 2:
Practice Address - City:LAKE HELEN
Practice Address - State:FL
Practice Address - Zip Code:32744
Practice Address - Country:US
Practice Address - Phone:386-748-2458
Practice Address - Fax:866-509-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18984261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0266OtherMEDICARE GROUP