Provider Demographics
NPI:1265928816
Name:STRICKLAND, GRACE ANNA
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANNA
Last Name:STRICKLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SCENIC HWY APT I1
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-8005
Mailing Address - Country:US
Mailing Address - Phone:918-637-1204
Mailing Address - Fax:
Practice Address - Street 1:1003 COLLEGE BLVD W STE 1
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1069
Practice Address - Country:US
Practice Address - Phone:850-279-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH8006225100000X
FL32523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist