Individual
JEREMY SHAKOURI WYDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4040 WINTER GARDEN VINELAND RD, WINTER GARDEN, FL 34787-9502
(407) 573-3361
(407) 395-8309
Mailing address
4040 WINTER GARDEN VINELAND RD, WINTER GARDEN, FL 34787-9502
(407) 573-3361
(407) 395-8309
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
29148
MD
225100000X
Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
Primary
PT39007
FL
Other
Enumeration date
07/20/2022
Last updated
06/07/2023
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