Provider Demographics
NPI:1013108034
Name:MATAJA, JACQUELINE MICHELE (PT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MICHELE
Last Name:MATAJA
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 1:7350 SANDLAKE COMMONS BLVD
Mailing Address - Street 2:SUITE #3315
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8040
Mailing Address - Country:US
Mailing Address - Phone:407-345-8500
Mailing Address - Fax:407-345-1146
Practice Address - Street 1:7350 SANDLAKE COMMONS BLVD
Practice Address - Street 2:SUITE #3315
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8040
Practice Address - Country:US
Practice Address - Phone:407-345-8500
Practice Address - Fax:407-345-1146
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist