Healthcare Provider Details

I. General information

NPI: 1285783084
Provider Name (Legal Business Name): L DAPHNE SKOUTELAS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINA DAPHNE SKOUTELAS

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 PENNSYLVANIA AVE STE 112
WILMINGTON DE
19806-1432
US

IV. Provider business mailing address

2401 PENNSYLVANIA AVE STE 112
WILMINGTON DE
19806-1432
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-8989
  • Fax:
Mailing address:
  • Phone: 302-655-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0001712
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: