Provider Demographics
NPI:1437843844
Name:STAKLINSKI, MICHAEL R (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:STAKLINSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 JENKS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5469
Mailing Address - Country:US
Mailing Address - Phone:850-248-1600
Mailing Address - Fax:850-248-1602
Practice Address - Street 1:11501 HUTCHISON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-3747
Practice Address - Country:US
Practice Address - Phone:850-248-1600
Practice Address - Fax:850-248-1602
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist