Provider Demographics
NPI:1902058696
Name:STRICKLAND, JEANNIE T (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:T
Last Name:STRICKLAND
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 1:2505 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:SC
Mailing Address - Zip Code:29541-3634
Mailing Address - Country:US
Mailing Address - Phone:843-629-9377
Mailing Address - Fax:
Practice Address - Street 1:2505 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:SC
Practice Address - Zip Code:29541-3634
Practice Address - Country:US
Practice Address - Phone:843-629-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC963314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility