Individual
JACQUELINE DANIELLE SHIFTLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
11301 CORPORATE BLVD STE 101, ORLANDO, FL 32817-8355
(800) 774-7785
(888) 345-7994
Mailing address
1409 PERIWINKLE CT., LAKELAND, FL 33811
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
20546
FL
Other
Enumeration date
02/03/2010
Last updated
08/06/2010
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