Basic Information
| Provider Information | |||||||||
| NPI: | 1528012309 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STRICKLAND | ||||||||
| FirstName: | JERRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2413 PROFESSIONAL DR | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278042254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524439103 | ||||||||
| FaxNumber: | 2524519032 | ||||||||
| Practice Location | |||||||||
| Address1: | 2413 PROFESSIONAL DR | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278042254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524439103 | ||||||||
| FaxNumber: | 2524519032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 12/08/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1248 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 195866 | 01 | NC | MED RISK | OTHER | 2743633 | 01 | NC | UHC | OTHER | 068ER | 01 | NC | BCBS | OTHER | 7057923 | 01 | NC | AETNA | OTHER | 7212406 | 05 | NC | MEDICAID | 197961 | 01 | NC | MEDCOST | OTHER |