Provider Demographics
NPI:1649610098
Name:STRACKER PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:STRACKER PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:THAD
Authorized Official - Last Name:STRACKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:714-865-1076
Mailing Address - Street 1:1421 N WANDA RD
Mailing Address - Street 2:STE. 120 V4
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5343
Mailing Address - Country:US
Mailing Address - Phone:714-865-1076
Mailing Address - Fax:
Practice Address - Street 1:1421 N WANDA RD
Practice Address - Street 2:STE. 120 V4
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5343
Practice Address - Country:US
Practice Address - Phone:714-865-1076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-30
Last Update Date:2013-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT296142251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty