Provider Demographics
NPI:1740914977
Name:OJEDA, JACLYNN E (PT, DPT, COMT)
Entity type:Individual
Prefix:
First Name:JACLYNN
Middle Name:E
Last Name:OJEDA
Suffix:
Gender:F
Credentials:PT, DPT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 CORKSCREW RD STE 10
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3216
Mailing Address - Country:US
Mailing Address - Phone:239-390-1656
Mailing Address - Fax:239-390-1686
Practice Address - Street 1:1309 N GREENFIELD RD STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4009
Practice Address - Country:US
Practice Address - Phone:480-210-1706
Practice Address - Fax:480-681-7143
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT38913225100000X
AZLPT-034139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist