Healthcare Provider Details

I. General information

NPI: 1346994639
Provider Name (Legal Business Name): SKINNER PHYSIOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 S COLLEGE AVE
FORT COLLINS CO
80525-3770
US

IV. Provider business mailing address

1740 CONCORD DR
FORT COLLINS CO
80526-1600
US

V. Phone/Fax

Practice location:
  • Phone: 970-430-6762
  • Fax:
Mailing address:
  • Phone: 662-316-1785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOHN MARK SKINNER
Title or Position: OWNER
Credential: PT, DPT
Phone: 662-316-1785