MEDICARE: SKINNER PHYSIOTHERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1346994639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKINNER PHYSIOTHERAPY LLC

Provider Business Mailing Address
First Line	:	1740 CONCORD DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1600
Country	:	US
Telephone Number	:	662-316-1785
Fax Number	:

Provider Business Practice Location Address
First Line	:	4848 S COLLEGE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3770
Country	:	US
Telephone Number	:	970-430-6762
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN MARK SKINNER
Credential	:	PT, DPT
Telephone Number	:	662-316-1785

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	02/07/2022

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