Provider Demographics
NPI:1710598933
Name:HARDING, JACQUELINE ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ELIZABETH
Last Name:HARDING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8326 NANDINA DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-9523
Mailing Address - Country:US
Mailing Address - Phone:941-378-4063
Mailing Address - Fax:
Practice Address - Street 1:5929 APPROACH RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5720
Practice Address - Country:US
Practice Address - Phone:941-444-7688
Practice Address - Fax:941-444-7689
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty