Provider Demographics
NPI:1710072020
Name:STRACKER, JASON THAD (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:THAD
Last Name:STRACKER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 N WANDA RD
Mailing Address - Street 2:# 120-V4
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5343
Mailing Address - Country:US
Mailing Address - Phone:714-514-1799
Mailing Address - Fax:
Practice Address - Street 1:959 E WALNUT ST STE 240
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1451
Practice Address - Country:US
Practice Address - Phone:626-795-2390
Practice Address - Fax:626-795-2391
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 296142251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic