Provider Demographics
NPI:1457360745
Name:SIKES, JENNIFER JEANE (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEANE
Last Name:SIKES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8391 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6048
Mailing Address - Country:US
Mailing Address - Phone:850-494-5403
Mailing Address - Fax:850-494-4910
Practice Address - Street 1:8391 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6048
Practice Address - Country:US
Practice Address - Phone:850-494-5403
Practice Address - Fax:850-494-4910
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA13545174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA13545OtherPTA LICENSE
FLPTA13545OtherPTA LICENSE