Wydra, Jeremy Shakouri

Wydra, Jeremy Shakouri is an individual health care provider with primary practice located at 4040 Winter Garden Vineland Rd , Winter Garden FL 34787-9502. He recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic is his primary health care specialty. Wydra, Jeremy Shakouri can be contacted via phone (407) 573-3361.

Contact Information

Primary practice address
4040 Winter Garden Vineland Rd Winter Garden FL 34787-9502
Phone: (407) 573-3361
Fax: (407) 395-8309
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 29148 Maryland
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic 2251X0800X PT39007 Florida

Profile Details

NPI number 1497480792
LBN Legal business name Wydra, Jeremy Shakouri
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 20th, 2022
Last updated Jun 7th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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