Healthcare Provider Details

I. General information

NPI: 1922968619
Provider Name (Legal Business Name): NATHAN SKOPAS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 NORWICH AVE
COLCHESTER CT
06415-1274
US

IV. Provider business mailing address

171 NORWICH AVE
COLCHESTER CT
06415-1274
US

V. Phone/Fax

Practice location:
  • Phone: 860-537-3014
  • Fax: 860-537-1420
Mailing address:
  • Phone: 860-537-3014
  • Fax: 860-537-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15217
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: